怎样做一个好医生

怎样做一个好医生 The Lancet Volume 376, Issue 9742, Pages 657-742 (28 August 2010-3 September 2010) Editorial 1.Chinese doctors are under threat 中国医生受到威胁 2.Why are drug trials in Alzheimer's disease failing? 为什么阿尔茨海默氏病药物试验失败, 3.What makes a good doctor? 怎样做一个好医生 Comment 4.Cancer research in the global village 地球村中的癌症研究 5.Improving interhospital paediatric transport 提高儿科转院的运输 6.STAT-C: a full revolution or just a step forward? STAT-C:完整的革命或只是向前迈进了一步, 7.The unfolding human tragedy in Pakistan: fighting alone 正在巴基斯坦展开的人间悲剧:孤军作战 8.The growing UK epidemic of human campylobacteriosis 英国日益增长的人弯曲杆菌病疫情 9.The James Lind Alliance: tackling research mismatches 詹姆斯林德联盟:处理研究不匹配 10.The potato: fertile ground for more funding 马铃薯:提供更多资金的肥沃的土壤 11.Offline: Nice airport, Aug 14, 2010 离线:尼斯机场，2010年8月14日 World Report 12.Medical tourism booms in India, but at what cost? 印度蓬勃发展的医疗旅游，但代价是什么, 13.A sprinkle of salt needed for Nepal's hidden hunger 一点盐对尼泊尔的隐性饥饿的需求 Perspectives 14.The proper ends do justify the means 正确目的的证明手段 15.Songs of “inexplicable splendour” “莫名其妙的辉煌”的歌 16.Bernard Pécoul: championing the cause of neglected diseases Bernard Pécoul:重视被忽视疾病的病因 17.Science as superstition: selecting medical students 科学迷信:选择医学生 Obituary 18.Stephen Henry Schneider 讣告:Stephen Henry Schneider(气候学家) Correspondence 19.Extensively drug-resistant tuberculosis in South Africa 南非广泛耐药的结核病 20.Extensively drug-resistant tuberculosis in South Africa 南非广泛耐药的结核病 21.Extensively drug-resistant tuberculosis in South Africa – Authors' reply 南非广泛耐药的结核病——作者回复 22.Multidrug-resistant tuberculosis in India 印度多重耐药的结核病 23.Where is diabetes in The Lancet's tuberculosis Series? 柳叶刀的肺结核系列的糖尿病在哪, 24.Opportunistic screening for type 2 diabetes in primary care 2型糖尿病在初级保健筛查的机会 25.Like-with-like comparisons? 类似的比较, 26.Like-with-like comparisons? – Authors' reply 类似的比较,——作者回复 27.Changing doctors in changing times 变迁的时代医生不断变化 28.Preventable cancer in the USA 美国可预防的癌症 29.Galen's “errors” 盖伦的“错误” 30.Department of Error 错误纠正 Articles 31.Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial 曲妥单抗联合化疗与单纯化疗治疗HER2阳性晚期胃癌或胃食管交界癌(ToGA)的比 较:3期，开放标记，随机对照试验 ToGA:Trastuzumab for Gastric Cancer) Yung-Jue Bang,* Eric Van Cutsem,* Andrea Feyereislova, Hyun C Chung, Lin Shen, Akira Sawaki, Florian Lordick, Atsushi Ohtsu, Yasushi Omuro, Taroh Satoh, Giuseppe Aprile, Evgeny Kulikov, Julie Hill, Michaela Lehle, Josef Rüschoff , Yoon-Koo Kang, for the ToGA Trial Investigators† Summary Background Trastuzumab, a monoclonal antibody against human epidermal growth factor receptor 2 (HER2; also known as ERBB2), was investigated in combination with chemotherapy for first-line treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer. Methods ToGA (Trastuzumab for Gastric Cancer) was an open-label, international, phase 3, randomised controlled trial undertaken in 122 centres in 24 countries. Patients with gastric or gastro-oesophageal junction cancer were eligible for inclusion if their tumours showed overexpression of HER2 protein by immunohistochemistry or gene amplification by fl uorescence in-situ hybridisation. Participants were randomly assigned in a 1:1 ratio to receive a chemotherapy regimen consisting of capecitabine plus cisplatin or fl uorouracil plus cisplatin given every 3 weeks for six cycles or chemotherapy in combination with intravenous trastuzumab. Allocation was by block randomization stratified by Eastern Cooperative Oncology Group performance status, chemotherapy regimen, extent of disease, primary cancer site, and measurability of disease, implemented with a central interactive voice recognition system. The primary endpoint was overall survival in all randomised patients who received study medication at least once. This trial is registered with ClinicalTrials.gov, number NCT01041404. Findings 594 patients were randomly assigned to study treatment (trastuzumab plus chemotherapy, n=298; chemotherapy alone, n=296), of whom 584 were included in the primary analysis (n=294; n=290). Median follow-up was 18?6 months (IQR 11–25) in the trastuzumab plus chemotherapy group and 17?1 months (9–25) in the chemotherapy alone group. Median overall survival was 13?8 months (95% CI 12–16) in those assigned to trastuzumab plus chemotherapy compared with 11?1 months (10–13) in those assigned to chemotherapy alone (hazard ratio 0?74; 95% CI 0?60–0?91; p=0?0046). The most common adverse events in both groups were nausea (trastuzumab plus chemotherapy, 197 [67%] vs chemotherapy alone, 184 [63%]), vomiting (147 [50%] vs 134 [46%]), and neutropenia (157 [53%] vs 165 [57%]). Rates of overall grade 3 or 4 adverse events (201 [68%] vs 198 [68%]) and cardiac adverse events (17 [6%] vs 18 [6%]) did not differ between groups. Interpretation Trastuzumab in combination with chemotherapy can be considered as a new standard option for patients with HER2-positive advanced gastric or gastro-oesophageal junction cancer. 32.Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study 英格兰和威尔士的专科检查团队对进入儿童重症监护病房的儿童雨后的影响:回顾性队 列研究 Padmanabhan Ramnarayan, Krish Thiru, Roger C Parslow, David A Harrison, Elizabeth S Draper, Kathy M Rowan Summary Background Intensive care services for children have undergone substantial centralisation in the UK. Along with the establishment of regional paediatric intensive care units (PICUs), specialist retrieval teams were set up to transport critically ill children from other hospitals. We studied the outcome of children transferred from local hospitals to PICUs. Methods We analysed data that were gathered for a cohort of children (?16 years) admitted consecutively to 29 PICUs in England and Wales during 4 years (Jan 1, 2005, to Dec 31, 2008). We compared unplanned admissions from wards within the same hospital as the PICU and from other hospitals; interhospital transfers by non-specialist and specialist retrieval teams; and patients transferred to their nearest PICU and those who were not. Primary outcome measures were mortality rate in PICU and length of stay in PICU. We analysed data by use of logistic regression analysis. Findings There were 57 997 admissions to PICUs during the study. Nearly half of unplanned admissions (17 649 [53%] of 33 492) were from other hospitals. Although children admitted from other hospitals were younger (median 10 months [IQR 1–55] vs 18 months [3–85]), sicker at admission (median predicted risk of mortality 6% [4–10] vs 4% [2–7]), stayed longer in PICUs (75 h [33–153] vs 43 h [18–116]), and had higher crude mortality rates (1384 [8%] of 17 649 vs 996 [6%] of 15 843; odds ratio 1?27, 95% CI 1?16–1?38), the risk-adjusted mortality rate in PICUs was lower than among children admitted from within the same hospital (0?65, 0?53–0?80). In a multivariable analysis, use of a specialist retrieval team for transfer was associated with improved survival (0?58, 0?39–0?87). Interpretation These findings support the policy of combining centralisation of intensive care services for children with transfer by specialist retrieval teams. 33.Efficacy of boceprevir, an NS3 protease inhibitor, in combination with peginterferon alfa-2b and ribavirin in treatment-naive patients with genotype 1 hepatitis C infection (SPRINT-1): an open-label, randomised, multicentre phase 2 trial Boceprevir，一种NS3蛋白酶抑制剂，联合聚乙二醇干扰素α- 2b和利巴韦林治疗感染 基因1型丙型肝炎病毒的初治患者的疗效(冲刺- 1):一个开放标签，随机，多中心2期临 床试验 Paul Y Kwo, Eric J Lawitz, Jonathan McCone, Eugene R Schiff , John M Vierling, David Pound, Mitchell N Davis, Joseph S Galati, Stuart C Gordon, Natarajan Ravendhran, Lorenzo Rossaro, Frank H Anderson, Ira M Jacobson, Raymond Rubin, Kenneth Koury, Lisa D Pedicone, Cliff ord A Brass, Eirum Chaudhri, Janice K Albrecht Summary Background Peginterferon plus ribavirin achieves sustained virological response (SVR) in fewer than half of patients with genotype 1 chronic hepatitis C virus infection treated for 48 weeks. We tested the efficacy of boceprevir, an NS3 hepatitis C virus oral protease inhibitor, when added to peginterferon alfa-2b and ribavirin. Methods In part 1 of this trial, undertaken in 67 sites in the USA, Canada, and Europe, 520 treatment-naive patients with genotype 1 hepatitis C virus infection were randomly assigned to receive peginterferon alfa-2b 1?5 μg/kg plus ribavirin 800–1400 mg daily for 48 weeks (PR48; n=104); peginterferon alfa-2b and ribavirin daily for 4 weeks, followed by peginterferon alfa-2b, ribavirin, and boceprevir 800 mg three times a day for 24 weeks (PR4/PRB24; n=103) or 44 weeks (PR4/PRB44; n=103); or peginterferon alfa-2b, ribavirin, and boceprevir three times a day for 28 weeks (PRB28; n=107) or 48 weeks (PRB48; n=103). In part 2, 75 patients were randomly assigned to receive either PRB48 (n=16) or low-dose ribavirin (400–1000 mg) plus peginterferon alfa-2b and boceprevir three times a day for 48 weeks (low-dose PRB48; n=59). Randomisation was by computer-generated code, and study personnel and patients were not masked to group assignment. The primary endpoint was SVR 24 weeks after treatment. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00423670. Findings Patients in all four boceprevir groups had higher rates of SVR than did the control group (58/107 [54%, 95% CI 44–64], p=0?013 for PRB28; 58/103 [56%, 44–66], p=0?005 for PR4/PRB24; 69/103 [67%, 57–76], p<0?0001 for PRB48; and 77/103 [75%, 65–83], p<0?0001 for PR4/PRB44; vs 39/104 [38%, 28–48] for PR48 control). Lowdose ribavirin was associated with a high rate of viral breakthrough (16/59 [27%]), and a rate of relapse (six of 27 [22%]) similar to control (12/51 [24%]). Boceprevir-based groups had higher rates of anaemia (227/416 [55%] vs 35/104 [34%]) and dysgeusia (111/416 [27%] vs nine of 104 [9%]) than did the control group. Interpretation In patients with untreated genotype 1 chronic hepatitis C infection, the addition of the direct-acting antiviral agent boceprevir to standard treatment with peginterferon and ribavirin after a 4-week lead-in seems to have the potential to double the sustained response rate compared with that recorded with standard treatment alone. Seminar 34.Gestational trophoblastic disease 妊娠滋养细胞疾病 Review 35.Endometriosis and infertility: pathophysiology and management 子宫内膜异位症与不孕:病理生理学和管理 Viewpoint 36.The rise and fall of the antimalarial Lapdap: a lesson in pharmacogenetics 抗疟疾药物拉普达的上升和下降:药理学课程 Case Report 37.A harmless high? 无害的升高,