Improving critical care for Americans with terminal illness
The Lancet Respiratory Medicine
Published: May 20, 2019
Use of intensive care unit (ICU) resources in the USA outpaces that of other countries. This increased use is not accompanied by superior clinical outcomes and is at times discordant with patient preferences.
For more than three decades, both medical professionals and the public have worried that patients may receive non-beneficial care in US ICUs during their final months of life. Some of these patients wish to avoid severe cognitive and physical impairments, and protracted deaths in the hospital setting. Recognising when intensive care admission will not restore a person’s health, and helping patients and families embrace goals related to symptom relief, interpersonal connection, or spiritual fulfilment are central challenges of critical care practice in the USA.
In this Series, we identify major drivers of ICU resource use in the USA and review trials from the past decade to better understand the interventions designed to address these challenges. The Series also presents reasons why evaluating, comparing, and implementing these interventions has been difficult. Through careful scrutiny of the design and interpretation of past trials we can show why improving goal concordant care has been so elusive, and suggest new directions for the next generation of research.
The microbiome in respiratory disease
The Lancet Respiratory Medicine
Published: April 9, 2019
The microbiome has been implicated in the pathogenesis and progression of a range of respiratory diseases. The huge potential of the microbiome as a rich source of therapeutic targets and of diagnostic and prognostic markers of disease is beyond doubt, but a concerted effort is needed to fill gaps in understanding and translate research findings into clinical interventions for improved health outcomes. In the first paper of this two-part Series, Charissa Naidoo and colleagues review the role of microbiota of the respiratory tract and gut in tuberculosis pathogenesis, treatment, and clinical outcomes. In the second paper, Kurtis Budden and colleagues provide an overview of the mechanisms by which microbes interact with host immunity, their role in the pathogenesis and exacerbations of chronic respiratory diseases, and their interactions with common therapies. The papers identify priorities for research and outline future directions for the field.
The future of cystic fibrosis care: a global perspective
The Lancet Respiratory Medicine
Published: September 28, 2019
Decades of progress in the care of people with cystic fibrosis mean that patients are living longer, healthier lives than ever before. However, the disease continues to limit survival and quality of life in high-income countries, and many patients in low-income and middle-income countries do not have access to integrated multidisciplinary care or affordable therapies. With a growing population of adult patients, widespread genetic testing for the diagnosis of cystic fibrosis, increased recognition of patient populations of non-European descent, and the development of potentially life-changing therapies that target the underlying cause of cystic fibrosis, an unprecedented opportunity exists for improved health outcomes. The Lancet Respiratory Medicine Commission, led by Scott Bell and Felix Ratjen, reviews the latest research advances and identifies challenges and opportunities for progress in the care of patients globally.
Drug-Resistant Tuberculosis
The Lancet Respiratory Medicine
Published: March 23, 2017
“Practices for the management of individual patients in settings with a high tuberculosis burden are not sufficient to prevent the emergence, amplification, and spread of drug-resistant tuberculosis” is one of the key messages from The Lancet Respiratory Medicine Commission, led by Keertan Dheda from the University of Cape Town, South Africa. The Commission focuses on multidrug-resistant, extensively drug-resistant, and incurable tuberculosis, and highlights the growing burden of disease, its implications for patient management, as well as social and legal aspects. The authors also provide practical solutions for tackling emerging resistant cases—an exponentially increasing concern in high-burden countries.