10+10: Rapid decisions and fast track publication for RCTs

For the Article roflumilast and exacerbations of chronic obstructive pulmonary disease see Lancet 2015; published online February 13. http://dx.doi.org/10.1016/ S0140-6736(14)62410-7

On April 5, 1997, The Lancet launched fast track: a service that published peer-reviewed and edited practice-changing research within 4 weeks. The decision arose from concern that delays in publication harmed patients, threatened originality, and risked results leaking out in the absence of context. Moreover, we saw the unrealised potential of electronic publication to drive, rather than only mirror, what appeared in print. Following that decision, several journals now offer expedited publication for selected submissions. In that era, it was editors who decided which manuscripts warranted fast track. Not anymore. The relationship between editors and authors has rightly shifted to one of greater engagement and welcome collaboration. Therefore, because randomised controlled trials (RCTs) provide the basis for many clinical decisions, we now invite authors of RCTs that have been sent for review, to determine which of their submitted trials should be fast tracked. To accomplish this, 48-hour fast track review is now standard for all RCTs sent for peer review by

The Lancet. Furthermore, we aim for a goal of 10+10: 10 working days to a final decision, and, if accepted, 10 working days from acceptance to online publication. To assure high quality, such a proposition depends on satisfactory reviews received in a timely manner with points that can be readily addressed, as well as a rapid revision by authors. It might not be appropriate for all RCTs and authors can opt for a more leisurely pace if they prefer. But for authors keen to publish practice-changing trials quickly, our editors are ready. Working together, the target is achievable, as shown by the publication today of an RCT by Fernando Martinez and colleagues that tests roflumilast for exacerbations of chronic obstructive pulmonary disease in patients with poor control. Getting peer-reviewed RCTs published more swiftly means that patients benefit sooner, related research is accelerated, and, ultimately, that solutions can be discovered more quickly. Towards that end, we invite researchers, reviewers, and funders to join us in speeding up science. „ The Lancet


Ebola in west Africa: getting to zero

Published Online February 10, 2015 http://dx.doi.org/10.1016/ S0140-6736(14)62478-8 See World Report page 591


Since December, 2013, Ebola has infected more than 22 500 people, mostly in west Africa, resulting in more than 9000 deaths. The disease has had a devastating effect on the region, on communities, economies, and health systems—more than 800 health workers have been infected, nearly 500 of whom have died. New cases of infection have been slowing down, however, leading the UN to estimate that the epidemic could be over (zero new infections, zero transmissions) by June this year. But caveats exist around this prediction. Several developments serve as reminders of the challenges the response still faces. After a steady decline, last week saw an increase in weekly incidence in all of the three main affected countries for the first time in 2015. 124 new cases were reported in the week to Feb 1 (39 in Guinea, five in Liberia, and 80 in Sierra Leone), 25 more than the previous week. Furthermore, widespread transmission— more than 10 900 cases in Sierra Leona, 8800 in Guinea, and 3000 in Liberia—and community resistance to health messages are still occurring. For example, an

unsafe burial took place in early January in Guinea in the eastern prefecture of Lola, which has so far resulted in 11 confirmed cases. Worryingly, Lola is on the border with CÔte d’Ivoire, raising fears about cross-border spread. Geographical spread of the disease has already increased in Guinea to a prefecture that borders Mali. The upcoming wet season is also of concern; remote areas will become harder to access once the rains hit. In view of the evolving epidemic, the UN containment strategy is shifting its focus. Last year, the sheer scale of new infections meant a clinical approach was needed to treat all those identified with Ebola. Now, the response is changing to a locally driven, public health approach—case identification, contact tracing, diagnosis, and treatment in the affected prefectures. To get to zero new infections, however, means identifying every case and every contact. Even with new infections waning, ending the outbreak will not be an easy task, and complacency by the international community and donors would be a mistake. Ebola is not yet under control. „ The Lancet www.thelancet.com Vol 385 February 14, 2015

Ebola in west Africa: getting to zero.

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