Search Medical Journals & Research Articles

[Perspectives] Is science diplomacy still possible?

In a world of strategic rivalry, fragmented multilateralism, and techno-nationalism, can science diplomacy still serve as a bridge for cooperation? There is an emerging consensus that global health must evolve as the scientific, technological, and geopolitical landscape is transformed. The classic post–Cold War model of science as a universal language is giving way to polycentric, politically constrained, but still vital forms of scientific cooperation. But how exactly should science and diplomacy engage?

[Perspectives] Naveen Thacker: immunisation advocate and paediatrics leader

Paediatrician Naveen Thacker, Executive Director of the International Pediatric Association (IPA), is a lifelong immunisation advocate and global paediatrics leader. He was a key player in India's eradication of polio in 2014, and has since worked to share the lessons worldwide. A key component for him is trust, and he and colleagues set up the IPA's Vaccine Trust Project, a training programme to help health professionals communicate effectively with the public about vaccination. “Vaccination saves lives.

[Comment] Offline: Watching the watchers (part 2)

The chief threat to health systems, according to Global Health Watch 7 (GHW7), comes from privatisation, financialisation, and corporatisation, trends that have only accelerated in recent decades, especially in Majority World settings. We surely all see examples in our own countries—the transfer of public assets to the private sector, the creation of public–private partnerships, and chronic resource starvation that forces people into the arms of private health providers. Financialisation implies an increasing role for markets in health care and the metamorphosis of health systems from services to tradable assets.

[Comment] The Lancet Commission on the Future of Ukraine's Health System

In the summer of 2017, champions of health system reform in Ukraine were holding their breath. Ukraine's Law on Government Financial Guarantees of Healthcare Services was set to go before the Parliament (Verkhovna Rada) in October, but it was unclear whether it would pass. The proposed changes were revolutionary for Ukraine. The Law would reform and modernise the country's health system that had long been characterised by excessive out-of-pocket and informal payments, inefficiency, and poor health outcomes.

[Comment] Post-separation abuse: an ignored public health crisis and preventable injustice

Violence against women and children are egregious human rights violations. Globally, intimate partner violence is the most common form of violence,1 with nearly one in three women having been subjected to “intimate partner violence or non-partner sexual violence”.2 “Psychological violence is the most common form of intimate partner violence”3 and can be considered worse than physical intimate partner violence. Six in ten children younger than age 5 years are regularly subject to psychological violence or physical punishment from parents and caregivers.

[Comment] Safety and immunogenicity of the Hendra virus recombinant soluble glycoprotein G Nipah virus vaccine in adults

Nipah virus (NiV) is a highly pathogenic zoonotic virus that has been responsible for recurrent outbreaks throughout south and southeast Asia with mortality rates ranging from 21% to 82%, making it into the list of WHO priority pathogens.1 Since its discovery in Malaysia in 1999, NiV has posed a serious public health and pandemic threat, particularly due to its potential for human-to-human transmission and the absence of licensed therapeutics or vaccines.2 Since 2001, the outbreaks have been reported in Bangladesh and India.

[Comment] Bundled interventions to prevent acute kidney injury: finding the value in supportive care

Acute kidney injury (AKI) is among the most common organ failures observed in the hospital and can irrevocably alter the trajectory of a patient's short-term and long-term health.1–4 The lack of pharmacological treatments for AKI has generated broad interest in applying supportive care strategies that reduce the condition's development and complications.5,6 Multi-faceted, or so-called bundled-care interventions, have shown promise for reducing the incidence of AKI in single-centre studies, particularly in the perioperative setting, where preventive treatments are more easily timed than with AKI that occurs during acute illness.

[Comment] Complete revascularisation in patients with acute myocardial infarction

Nearly half of patients with acute myocardial infarction, including ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI), have multivessel disease with significant stenoses in non-culprit vessels, and these patients showed higher risks of death or re-infarction after primary percutaneous coronary intervention (PCI).1 There have been three clinical questions in the treatment of patients with acute myocardial infarction and multivessel disease.

[Comment] TAVI for native aortic regurgitation

Transcatheter aortic valve implantation (TAVI) for severe, isolated, native aortic regurgitation has been challenging with use of transcatheter heart valves designed for aortic stenosis (off-label use). In several registry studies in which transcatheter heart valves were used to treat aortic regurgitation, the main concerns with this approach were the lack of leaflet calcification (which hinders valve anchoring and increases the risk of procedural failure), the frequent bicuspid valve anatomy, high rates of valve embolisation (6·4–15%), and paravalvular regurgitation (10%).

[Editorial] Universal health coverage: necessary, but not enough

Universal health coverage (UHC) rests on a simple idea: every person, everywhere, should be able to access the health services they need without fear of financial ruin. Across history, societies have recognised that health is a collective responsibility—from paid sick leave in ancient Egypt, to Bismarck's social insurance model in 19th century Germany and the clarion call of the 1978 Alma-Ata Declaration. In 2015, this principle was woven into the Sustainable Development Goals (SDGs), with governments committing to expand service coverage and shield households from catastrophic health spending by 2030.

Listening to Understand in Medical Poetry

One essential beauty of art rests in its ability to express its creator’s internal self. Medicine similarly involves an opening of unseen worlds—through history-taking, laboratory results, and imaging, clinicians can access scientific dimensions of patients that are shielded from view, which can sometimes lead to inadvertently appropriating the illness narrative. Patients also offer physicians other intimations of themselves that go beyond chief concerns and data—their feelings. How clinicians have personally coped with or been trained to receive these glimpses into a patient’s emotional world is complex. Yet Sir William Osler is reported to have said, “Listen to the patient. [They are] telling you the diagnosis.” Perhaps the value of listening lies not only in solving diagnostic problems but also in more deeply understanding who a patient is. The poem “If She Has to Go” portrays a grandmother candidly sharing her inner thoughts about the end of her life. With “legs uncharacteristically exposed” as hospital discharge approaches, her embrace of death contrasts sharply with the medical team’s reassurance of restored health. The tension builds ironically, as it is the patient diagnosed with dementia who so clearly insists on the ultimate medical futility of her case, while the physicians (however patient-centrically) blithely urge continued temporizing care. As the poem concludes, all understand exactly what this patient wants despite her dementia, a “shroud with dancing opacity.” With a “sense of/contentment” and as “her shroud thin[s],” poetry ushers in a metaphorical unveiling of mutual acceptance of mortality: “if she has to go, she has to go.”

If She Has to Go

My grandmother says she is sorry to be leaving us, but if she has to go, she has to go. She twists the hem of her hospital gown between two arthritic fingers, her knuckles at jagged angles, her legs uncharacteristically exposed. Her dementia is a shroud with dancing opacity. The doctor is pleased with her progress, is sending her home. But she tells me to be sure of her burial plot. She is tired. She is sorry to be leaving us. She has accomplished everything, everything, a refrain that emerges even as she swats at her nurses. She is oriented only to a sense of contentment. We tell her she is getting better, will go home, but she declines. She is ready to go. Why does it have to be such a good life, she asks, her shroud thinning, and then only suffering at the end?

Error in Denominator in Results Text

The Original Investigation titled “Iodine Seed−Marking Protocol for Response-Guided Axillary Treatment After Systemic Therapy for Node-Positive Breast Cancer,” published online on August 28, 2025, and in the October 2025 issue, incorrectly stated in the Results section that the denominator used to calculate the percentage of patients diagnosed with invasive residual breast disease who received adjuvant systemic treatment was 215; instead, these 34 patients (16%) were from among the 135 patients with ypN0 disease. This article was corrected online.

[Articles] Development and validation of the NEOS2 score for prediction of long-term outcomes and improvement after first-line immunotherapy in patients with anti-NMDAR encephalitis: an international cohort study

The NEOS2-score, readily available at diagnosis and easy to apply, can identify patients with either a favourable or poor prognosis, and those who may benefit from early intensified treatment. The value of the NEOS2-score for guiding treatment decisions and as a stratification tool in studies on optimal treatment regimens, should be confirmed in further prospective studies.

[Health Policy] Building a health system resilience framework: national, state, regional, and local perspectives

Health system resilience (HSR) is essential to sustaining equitable essential functions under acute and chronic stressors in decentralized systems. We developed and validated a Brazil-tailored HSR framework that distinguishes steady-state performance from resilience-specific capacities and assigns responsibilities across federal, state, regional, and municipal levels. Using a three-phase qualitative deductive–inductive approach with 48 international and national experts, we identified nine dimensions, 18 subdimensions, and 65 indicators that prioritise governance coherence, surge workforce strategies, emergency regulation, real-time monitoring, and access to critical technologies.