Read more]]> Mental health is a tricky branch of medicine – psychiatrists deal with significant diagnostic and research challenges, and some patients struggle with the stigma they may face socially due to having a mental disorder. In a bid to educate the public about psychiatric conditions, Mental Health Awareness Week, which this year runs from 13th–19th May, is focusing on raising awareness about how exercise can positively affect mental health. In fact, there is increasing focus on modifying key lifestyle factors as primary prevention strategies for mental health disorders, and in a recent opinion article published in BMC Medicine, Felice Jacka and colleagues argue that depression and anxiety should be ranked amongst prevalent medical conditions affected by poor diet and physical inactivity. In another opinion article, Almudena Sanchez-Villegas and Miguel Martínez-Gonzalez discuss how diet may help prevent depression, and recommend that observational studies and clinical trials need to be carried out to confirm the association.

Psychiatry is also very topical this week due to the imminent release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association. This has been undergoing revision for some time, and although greatly anticipated, has also led to much debate, with some arguing that the DSM-5 should not be heralded as the ultimate guide in diagnosing psychiatric disorders. To focus on the many controversies in this area of medicine, a new article collection, Current Controversies in Psychiatry, has been published in BMC Medicine to address the current challenges in psychiatry from diagnosis to co-morbidities.

As Michael Berk discusses in an editorial to launch our article collection, the debate on diagnostic categories in mental health based on DSM-5 is disproportionate to what the changes will actually mean. He highlights that while the modifications in diagnostic criteria are useful, the limitations should also be kept in perspective amongst clinicians and regulators, and warns that adhering too tightly to imperfect criteria will hamper progress in research.

In a debate article, Ian Hickie and colleagues argue that the diagnostic criteria can be improved by developing new approaches that identify pathways underlying the illnesses rather than using broad categories to describe psychiatric disorders. However, in another debate article, Victoria Cosgrove and Trisha Suppes highlight that boundaries between the diagnosis of bipolar disorder I, schizophrenia and schizoaffective disorder are preserved in the DSM-5 criteria, as there is not yet enough data to justify a continuous model of psychosis.

It should be noted that the DSM diagnoses are based on consensus guided by clinical symptoms, and are not derived from any quantifiable research measures. Another closely related diagnostic guideline is the tenth edition of the International Classification of Diseases (ICD-10) developed by the WHO, which is also undergoing revision (the ICD-11 is due for release in 2015); some argue that the two sets of guidelines, although developed for use by different branches of health professionals, suffer from similar limitations.

In an attempt to produce a more informative set of diagnostic guidelines, the National Institute of Mental Health (NIMH) launched the Research Domain Criteria (RDoC) project in 2009, which aims to incorporate genetics, neuroimaging and cognitive science to develop a new classification system. In a debate article, Bruce Cuthbert and Thomas Insel argue that future psychiatric nosologies will be informed by the RDoC, which will help achieve precision medicine for mental disorders. Thomas Insel expands on this project further in his NIMH blog. The move towards focusing on a more personalized approach to psychiatric research is also highlighted in a review article by Charles Nemeroff and colleagues, where the genetics, epigenetics, biomarkers, treatment response and environmental factors of mood disorders and schizophrenia are discussed, with particular emphasis on the impact of neuroimaging on personalized medicine in psychiatry.

The patient’s perspective in all this should also not be forgotten, and as Dan Stein and Katherine Phillips point out, the fifth DSM revision incorporated public feedback for the first time. Stein and Phillips both worked as part of the subgroup for the obsessive compulsive and related disorders criteria, and in a commentary describe the importance of taking patient opinion into account.

One thing that cannot be underestimated is the impact psychiatric conditions have on overall health. In particular, depression has been associated with obesity and cardiovascular diseases (CVD), and in a review article Brenda Penninx and colleagues examine the biological pathways and the dysregulation between depressive symptoms and somatic health. Additionally, Peter de Jonge and colleagues argue that although there is a link between coronary heart disease (CHD) and depression, this association is confounded by heterogeneity, such that depression is a non-causal risk factor for CHD. However, Kenneth Freedland and Robert Carney dispute that depression predicts CHD but admit that better methods are required to ascertain whether depression is a causal risk factor for CHD, which could help determine treatment strategies for CVD prevention.

Further articles will be added to this series to focus on some of the controversies and open questions in psychiatry, so keep an eye out for developments in our article collection. In the meantime, we wish you good mental health!

In recognition of this, we have collated 10 articles related to asthma control, published across some of BioMed Central’s journals in the last year. This collection includes articles such as Exploring factors influencing asthma control and asthma-specific health-related quality of life among children published in Respiratory Research, an article from BMC Medicine looking at the appropriateness of

Read more]]> World Asthma Day is organized annually by the Global Initiative for Asthma (GINA), in support of the estimated 300 million people with asthma across the globe. The ongoing theme for events taking place is “You can control your asthma”. This year, GINA has introduced a sub-theme, “It’s time to control asthma”.

In recognition of this, we have collated 10 articles related to asthma control, published across some of BioMed Central’s journals in the last year. This collection includes articles such as Exploring factors influencing asthma control and asthma-specific health-related quality of life among children published in Respiratory Research, an article from BMC Medicine looking at the appropriateness of apps for asthma self-management, and research linking improper inhaler technique with poor asthma control and frequent emergency department visits published in Allergy, Asthma & Clinical Immunology. There are additional contributions from BMC Pulmonary Medicine, Multidisciplinary Respiratory Medicine and Clinical and Translational Allergy.

Clinical and Translational Allergy, an official journal of European Academy of Allergy and Clinical Immunology, have also recently published the abstracts from the EAACI conference International Severe Asthma Forum held in October last year. The abstracts showcase some of the latest research in the field presented at ISAF.

Check out our Respiratory and Allergy and Immunology Gateways to stay up to date with asthma research published across BioMed Central journals.

Read more]]> Systemic lupus erythematosus (SLE), commonly known as “lupus”, is an autoimmune disease that can affect any of the body’s organs or tissues. The symptoms of SLE are very diverse, ranging from skin rashes to kidney failure, and patients experience flares followed by periods of remission. Steroids are commonly used to treat SLE flares, but as long-term use leads to serious side effects, newer treatments aim to reduce or stop steroid use altogether. In a review article published in BMC Medicine, David D’Cruz and colleagues from St Thomas’ Lupus Trust review the novel therapies in clinical development for SLE treatment. The authors discuss how conventional treatments are not appropriate for all patients due to problems with resistance and toxicity, and describe the exciting future prospects of using biologic agents to target the overactive immune system and treat SLE.

Immune dysregulation is also thought to be involved in atherosclerosis and cardiovascular disease. While a number of factors, such as a high-fat diet, smoking and high blood pressure, are known to accelerate the development of atherosclerotic plaques, increasing evidence points towards inflammation as a process that can be targeted therapeutically. Johan Frostegård from the Karolinska Institute describes the inflammatory processes involved in atherosclerosis in a review article, and explains the underlying mechanisms. Surprisingly, no immune modulatory agents are currently used to treat atherosclerosis; Frostegård discusses a number of therapies targeting inflammation that have potential to ameliorate atherosclerosis, and concludes that more studies are required to show whether such treatments are effective and to confirm the link between immunity and CVD.

As with atherosclerosis, chronic stimulation of the immune system is being linked to an increasing number of conditions, and many diseases of unknown etiology are believed to be of autoimmune origin. In a video Q&A, Yehuda Shoenfeld from Tel-Aviv University talks to BMC Medicine about “Autoimmune (Autoinflammatory) Syndrome Induced by Adjuvants”, or ASIA. Shoenfeld describes how siliconosis, Gulf war syndrome, macrophagicmyofasciitis syndrome and post-vaccination phenomena are all linked to previous adjuvant exposure; in 2011 this observation led Shoenfeld to propose these conditions should be grouped together as a common syndrome, ASIA. Shoenfeld recommends that ASIA should be treated as an autoimmune disease, and that clinicians should consider prescribing biologic immune modulatory therapies to patients with the syndrome.

Further research and reviews on autoimmune disorders can be freely accessed in our new article collection, Cutting edge: issues in autoimmunity, guest-edited by Yehuda Shoenfeld and Nancy Agmon-Levin. This collection aims to cover the issues at the forefront of autoimmunity and highlight new research in the field. If you would like your work to be considered as part of the series please send a pre-submission enquiry to bmcmedicineeditorial@biomedcentral.com.

Read more]]> Autoimmune diseases occur due to chronic stimulation of the immune system, leading the body to attack its own healthy tissues and organs. A wide variety of conditions, such as Type 1 diabetes, rheumatoid arthritis and celiac disease, are classified under this disorder. In addition, many diseases of unknown etiology are also believed to be of autoimmune origin, such as scleroderma and systemic lupus erythmatosous. However, the complex immunopathogenesis makes it difficult to effectively treat and manage many of the diseases. In some cases, there is controversy over the classification – for example at the CORA 2013 congress in Budapest last week, an hour-long debate moderated by Marco Matucci-Cerinic on the best way to treat scleroderma failed to reach a consensus- the main limitation being the elusive etiology of the disease. Additionally, some expressed their doubt over the autoimmune status of scleroderma and suggested that current treatment regimes that target the end stage, i.e. inflammation, may not be the best method of treatment.

In the late 90s, autoimmunity research was revolutionized by the successful introduction of biological compounds,namely the TNF-alpha inhibitors. However, much work is still needed to ensure that patients are diagnosed and treated early to prevent progression of the diseases. Yehuda Shoenfeld, a key researcher in the field of autoimmunity, emphasizes that the real focus should be on deciphering the origin of autoimmune diseases and the causal factors, rather than on how to treat the end stages. Based on discussions at multiple sessions at the CORA 2013 meeting, it seemed evident that there is a shift in focus towards epigenetics and personalized medicine, so keep an eye out for key developments in this field!

Another topic that elicited much debate at the congress was when and how to use biological compounds in the treatment of autoimmune disorders. Bearing Primum non nocere in mind, Ronald van Vollenhoven moderated a debate on the off-label use of biological therapy in pregnant patients who do not respond to other anti-inflammatory drugs , while Paul-Peter Tak passionately argued for the early start and stop of biological compounds in rheumatoid arthritis patients, as these have fewer side effects than the more commonly used methotrexate. One issue most agreed on was that the main limitation regarding biological therapy is the actual cost of the drugs, which limits access for many to this form of therapy.

In recognition of the ongoing controversies and research in this complex area of medicine, BMC Medicine has launched a new article collection, Cutting edge: issues in autoimmunity. In an editorial, guest editors Yehuda Shoenfeld and Nancy Agmon-Levin discuss the “mosaic of autoimmunity” and highlight some of the key findings and discussions of the 15 papers that so far have been included in the collection. The series comprises a review by Ziv Rosman et al. on biologic therapy in autoimmune diseases, and a review by Angela Tincani et al. on treatment options for Sjögren’s syndrome.

Ultimately, clinicians and patients have a common goal- fast diagnosis, and early treatment. This article collection of original research, review and commentaries sets out to answer some of the open questions in autoimmunity research. We will be adding further articles to the series throughout the year, so if you would like us to consider your work for inclusion please send a pre-submission query to bmcmedicineeditorial@biomedcentral.com.

This week, BMC Medicine attended the Evidence Live 2013 conference in Oxford, held on the 25th and 26th of March. Attracting around 1000 delegates, the conference provided ...

Read more]]> Evidence-based medicine (EBM) aims to assess the strength of proof behind medical interventions in terms of risks and benefits, and therefore can be used to inform clinical decision making on both an individual and a population basis. As such, EBM is crucial in maintaining quality medical care and ensuring good clinical outcomes. Many parties are involved in EBM. Firstly, researchers and publishers are involved in the conduct and dissemination of medical evidence. Then, policy makers and clinicians are responsible for the eventual implementation of changes in healthcare decisions that may occur.

This week, BMC Medicine attended the Evidence Live 2013 conference in Oxford, held on the 25^th and 26^th of March. Attracting around 1000 delegates, the conference provided stimulating debate over the current status and future directions of EBM and evidence-based practice. The topic that provoked substantial debate was regarding breast cancer screening. Peter Gøtzsche from the Nordic Cochrane Centre provided convincing evidence against the use of mammography. However, it seems that the evidence is still far from clear – this debate has been the subject of several articles in BMC Medicine this year, which were highlighted in a recent blog.

EBM in low income settings was also discussed, which can sometimes be problematic due to lack of resources. However, Kath Maitland gave an excellent example of EBM in Kenya. She discussed the results from the Fluid Expansion as Supportive Therapy (FEAST) study, where African children with severe febrile illnesses given the intervention of rapid fluid bolus exhibited excess mortality compared with controls. This was exactly the opposite result to what was expected. She presented the initial trial, and  also the secondary analysis of this data, which was recently published in BMC Medicine. Here, authors explored the mechanisms behind the excess mortality, finding that it was due to cardiovascular collapse rather than fluid overload.

Another hot topic in EBM touched upon publication, and publication bias. Ben Goldacre highlighted the importance of publishing negative results. Unfortunately, many authors, and many journals, are not keen to publish negative trial results as these are deemed to be not as exciting or citeable. As a consequence,  there is a bias caused by over-representation of positive effects of a particular intervention, which could be potentially harmful when applied to clinical decision making based on this ”evidence”. In an attempt to prevent this, he advocates that all trials should be both published and registered, which is the basis of the AllTrials campaign.

Of course, individuals are only able to make informed decisions based on appropriate evidence if they are able to access the data in the first place. This may be a problem if that data is behind a subscription wall. In an exciting session on the latest developments in publishing, the benefits of open access (OA), as well as open peer review, were discussed by Ginny Barbour and Trish Groves. As part of BioMed Central, which is the founder of OA,  BMC Medicine is a strong  supporter of this mode of publishing, promoting “knowledge for all”.

Evidence Live prompted much needed debate in the field of EBM within the key stakeholder groups. It is hoped that continued discussion among the different disciplines involved will further improve EBM and, consequently, healthcare.

Last week BMC Medicine attended a panel discussion on open access as part of the Cambridge Science Festival, chaired by Prof John Naughton, which discussed this significant development. Cameron Neylon, Advocacy Director at PLOS, kicked off discussions by describing the ...

Read more]]> Recent times have seen important advances in open access publishing. Earlier this month, the Research Councils UK (RCUK) announced their revised open access policy, which comes into effect from April 1^st 2013, and states that all RCUK-funded research must be published open access. While the RCUK support both green and gold open access options, they strongly encourage the gold model, as recommended by the Finch Report on expanding access to research findings.

Last week BMC Medicine attended a panel discussion on open access as part of the Cambridge Science Festival, chaired by Prof John Naughton, which discussed this significant development. Cameron Neylon, Advocacy Director at PLOS, kicked off discussions by describing the benefits of open access publishing, arguing that we have a duty of trust to maximize the impact of scholarship by making publicly-funded research accessible to all. The Wellcome Trust’s efforts to make research publicly available were discussed by Policy Advisor David Carr, who agreed with the importance of the RCUK’s policy and described how all research funded by the Wellcome Trust must be made available on PubMed Central. Carr explained that, surprisingly, only 55–60% of research is compliant with their open access publishing policy; a great deal of progress with compliance has been made since 2006 but more work is needed. In June 2012, sanctions were introduced to encourage all researchers to conform with the open access policy; Carr discussed how the Wellcome Trust check compliance with the policy before renewing grant payments as a measure to encourage open access publishing. Both Neylon and Carr emphasized that we need to ensure open access publishing is sustainable in resource-limited settings, highlighting that BMC’s Open Access Africa initiative is a promising step forward.

Neil Hammond, Senior Commissioning Editor at Cambridge University Press, followed with a caution about how we must provide publishing models to suit the needs of different research communities. Hammond explained how needs differ between the fields of medicine, humanities and social sciences; the latter groups have less funding available for publishing and so the “author pays model” is less viable. Rupert Gatti discussed how Open Book Publishers, of which he is a co-founder, publish monographs in the humanities that are freely available online, but also produce print copies in order to sustain the business model while disseminating research to all.

In the Q&A session following the speakers’ presentations, the panelists discussed open peer review; Neylon and Hammond agreed that it is important to experiment with different types of review and Neylon emphasized that peer reviewers should be recognized for their hard work using the open review system. The speakers agreed that open review works well in the medical sciences, as demonstrated by the BMC medical journals’ system.

The panel discussion demonstrated how great progress has been made in moving towards free dissemination of research to all, but further work is required to emphasize the importance of open access to all researchers and develop feasible models across all disciplines. BioMed Central supports the RCUK’s open access policy and is working hard to achieve sustainable funding models through institutional membership and our open access waiver fund.

On the topic of therapies, Ian Hickie and colleagues recommend that sleep-wake cycles and circadian systems are ...

Read more]]> Common psychiatric and neurodegenerative disorders are mainly treated using medications that modify the activity of monoamine neurotransmitter systems. New lines of pharmacological therapeutics for some of these disorders are emerging that target pathophysiological pathways, including inflammation, circadian and sleep patterns. Interestingly, sleep disorders are frequently associated with mental health particularly depression, whereas motor symptoms characterize Parkinson’s disease, a progressive neurodegenerative disease showing loss of dopaminergic neurons. Other progressive diseases such as neuromuscular diseases are more difficult to diagnose and quantify. These topics are highlighted in some recently published articles in BMC Medicine that we discuss below.

On the topic of therapies, Ian Hickie and colleagues recommend that sleep-wake cycles and circadian systems are targets for mood disorders. Individual differences in circadian physiology are suggested to advance the personalized approach to patient treatment in clinical psychiatry based on behavioral and pharmacological interventions.

Furthermore, other aspects of sleep have been addressed in psychiatry by Yves Dauvilliers and colleagues who review studies that have examined symptoms of mood disorders in hypersomnia, a specific sleep disorder. The authors additionally describe hypersomnia assessment methods and suggest that further interventional studies are required to explore the bidirectional association of sleep symptoms and mood disorders.

Continuing on the theme of treatment options, Michael Berk and colleagues review the potential of aspirin as a therapeutic agent in neurological and psychiatric disorders including depression, schizophrenia, bipolar disorder and Alzheimer’s disease. This literature appraisal reveals a suggested role for aspirin in regulating inflammation, oxidative and nitrosative stress and mitochondrial dysfunction in the brain. Further research will be needed to fully elucidate the clinical potential of this drug in psychiatry and neurology.

Focusing on neurodegenerative diseases, dyskinesia is a major complication in the treatment of Parkinson’s disease with dopaminergic agents and is associated with motor dysfunction. Christian Duval and colleagues have recently proposed a new approach to manage the level and type of motor symptoms to help improve patients’ quality of life and reduce the burden on health care systems.

Other disorders that affect motor function include neuromuscular diseases and the current morphological assessment of them is subjective and non-quantifiable. A new diagnostic tool based on a network science analysis helps to diagnose muscular dystrophies and neurogenic atrophies in a quantifiable manner. This evaluation will help monitor disease progression in both clinical and pre-clinical settings.

Together, the latest evidence highlights the need for new drug treatments for patients with neuropsychiatric disorders. In the case of neurodegenerative diseases, improved diagnosis and better management of patients in the clinic will provide early treatment and benefit their care.

The conference was particularly exciting because of the recently published Global Burden of Disease Study 2010 (GBD 2010) – a series of articles on how the international disease burden has changed since 1990. Although people are living longer due to decreases in the burden of infectious diseases and malnutrition, non-communicable diseases, such as cancer and cardiovascular disease, are on the ...

Read more]]> BMC Medicine recently attended the Consortium of Universities for Global Health (CUGH 2013) conference on global health, which took place in Washington D.C. from the 14^th-16^th March. Around 1400 delegates participated, with a broad range of expertise, such as those involved in general medicine, surgery, policy making, and governance, reflecting the broad scope of this field.

The conference was particularly exciting because of the recently published Global Burden of Disease Study 2010 (GBD 2010) – a series of articles on how the international disease burden has changed since 1990. Although people are living longer due to decreases in the burden of infectious diseases and malnutrition, non-communicable diseases, such as cancer and cardiovascular disease, are on the rise. Chris Murray, one of the lead authors of this landmark set of articles, gave an excellent presentation summarising the findings, and demonstrating his research facility’s visualisation tool of the data. One of the future aims of the study is to expand analysis of the data, add health forecasts and track health expenditure. It is hoped that this ambitious project will eventually be able to link the size of each disease burden with various risk factors, which one can then use to create policies in order to address the problem.

Global heath aims to improve health and achieve equity in the health status of all, regardless of their economic situation. This is of particular importance in resource-limited settings, and also in countries without sufficient health coverage, since healthcare expenditure due to disease or injury can often mean a family crossing into poverty, and healthcare systems may not have the resources needed to appropriately treat an individual.

How should we address such disparities in health? Universal healthcare, discussed in the opening keynote lecture, is an obvious strategy, but this has limitations with regards to the resources of that country. One such resource is the healthcare system itself, created by the body of healthcare professionals.  Unfortunately, ‘brain drain’ has become a problem in, for instance, African countries, where healthcare professionals will leave their country for better financial opportunities, creating a healthcare void. This was discussed in a session on the Medical Education Partnership Initiative (MEPI) – a medical education program aiming to increase physician retention in African countries. Fitzhugh Mullan and colleagues discussed the challenges and results from this intervention.

Dispersion of knowledge is a powerful way in which to improve health, but this, too, is subject to inequality. Agnes Binagwaho, who is Minister for Health in Rwanda, gave a series of excellent lectures on global health policy. One of the issues raised, and particularly important for global health, was access of evidence based medicine for resource-limited settings. She highlighted that such evidence should be freely accessible for all, and advocated that global health articles should be published in Open Access journals.

As an Open Access journal itself, BMC Medicine is committed to providing ‘knowledge for all’. We have recently launched our Medicine for Global Health article collection, which aims to explore health care innovations and policies, health economics and implementation, and research into the control and treatment of communicable and non-communicable diseases that have implications for global health. Articles offering novel insights into public health initiatives, health care policies, economics, and research into the control and treatment of communicable and non-communicable diseases that have implications for global health are invited to be submitted to BMC Medicine as part of this article collection.

Many ...

Read more]]> Care of vulnerable populations constitutes a sizeable proportion of those in need of medical resources, and there exists considerable disparity between those who can, and can’t afford  access to medical services.  Although these issues have always existed, concerns over global health and health inequities have been emphasized over recent years. For instance, few will forget the devastation caused by Hurricane Sandy in November 2012, where much of the focus was on the U.S., despite the fact that the devastation caused by the hurricane was far more severe in Haiti. As a country that is much more restricted in terms of resources, the impact on livelihood and medical facilities was far greater to the residents of this area.

Many researchers and physicians from a wide variety of disciplines are engaged in bringing awareness to, and improving global health, which is an area of medicine that ‘places a priority on improving health and achieving equity in health of all people worldwide’. This growing interest in also apparent from the Global Burden of Disease study (GBD 2010), which published a series of  articles exploring the worldwide distribution of disease using global data from the past decade,with an aim to better understand the health priorities for the global community.

In light of this hugely important area of medicine and research, BMC Medicine has launched the Medicine for Global Health article collection, with guest editors Gretchen Birbeck and Raymond Hutubessy. This collection aims to explore  public health initiatives, health care policies, health economics, and research into the control and treatment of communicable and non-communicable diseases that have implications for global health.

Gretchen Birbeck launches our article collection with an   editorial, discussing the increasing relevance of  medicine in resource-limited settings, highlighting that simple interventions may help to lessen the global burden of disease. Gretchen, who is based in southern Africa for half of the year, has first-hand experience of managing epilepsy in resource-limited settings, and in an interview, she talks about her personal experiences in this area.

You can also listen to Lin Lee’s interview with Gretchen Birbeck  in this podcast:

Raymond Hutubessy, based at the World Health Organization (WHO), is a health economist who specializes in economic analyses underlying decisions on whether or not to introduce vaccines against, for example, Human papillomavirus (HPV). In his Q&A  for the launch of the article collection, he discusses why this is of particular importance in resource-limited settings.

Ethical issues associated with global health research are discussed by James Giordano in an interview. He highlights that low- and middle- income countries are often the ones in most need of modern medical care, yet there exists an asymmetry in terms of research needs and research funds.

You can also listen to Sabina Alam’s interview with James Giordano in this podcast:

Often, the main concern is whether or not the intervention or research required is sustainable in the host country. This subject is touched upon in a bibliometric analysis by Charles Wiysonge and colleagues. They find that since the onset of the Expanded Program on Immunization, vaccine research productivity in Africa has skewed towards those funded by private means, with researchers from Africa having less research input, suggesting a need for  better communication between all stakeholders.

The article collection also includes a research paper by Kathryn Maitland et al., who previously published extremely surprising results from the Fluid Expansion as Supportive Therapy (FEAST) study. Here, African children with severe febrile illnesses given the intervention of rapid fluid bolus exhibited excess mortality compared with controls –  the opposite result to what was expected. In a secondary analysis of this data published in BMC Medicine, the authors explored the mechanisms behind the excess mortality, finding that it was due to cardiovascular collapse rather than fluid overload. Clarifying the mechanisms behind death in this population of patients has implications for fluid resuscitation practices in other populations of critically ill patients, an issue that is further emphasized in a linked commentary by John Myburgh and Simon Finfer.

It is hoped that the Medicine for Global Health article collection will highlight and ultimately help to resolve some of the medical concerns affecting global health. Articles offering novel insights into public health initiatives, health care policies, economics, and research into the control and treatment of communicable and non-communicable diseases that have implications for global health are invited to be submitted to BMC Medicine as part of this article collection.