Oxygen and stroke is an example of too much medicine that has been shown from the results of a randomised trial Carl Heneghan There seem to be a plethora of trials recently on Oxygen. I blogged about its use here in MI, and we published in BMJ EBM in patients without hypoxia in ST elevation MI […]
Category: Carl Heneghan
Evidence Watch: Can clinical decision support tools optimise anticoagulant therapy?
High baseline adherence rates for guidelines recommendations means that a clinical decision support system makes only a small difference in clinical outcomes for atrial fibrillation patients. Carl Heneghan The evidence for the association of atrial fibrillation with stroke risk is clear. However, there remain persistent levels of under treatment in clinical practice. Clinical decision […]
Evidence Watch: Is the smartphone useful for diagnosis?
The smartphone could prove to be a useful aid to diagnostics, but it is essential we take a critical approach to evidence that claims benefit for such applications. Carl Heneghan It isn’t long ago that a phone did just one thing but now it’s a mobile computer. It was with this in mind that a […]
Evidence Watch: should ‘rooming in’ be the norm?
Evidence suggests rooming-in should be the norm in hospitals but what factors will limit uptake Carl Heneghan Here’s what we selected this week: Daily vs intermittent antituberculosis therapy for pulmonary tuberculosis in patients with HIV a randomized clinical trial. JAMA Internal Medicine, 178(4), 485–493. Bottom line: HIV-positive patients with pulmonary TB receiving antiretroviral therapy, do […]
Frailty’s impact on mortality
A systematic review concludes that frailty is a predictor of mortality, but does it aid decision making in practice? Carl Heneghan A recent systematic review included 18 cohort studies including 65,048 participants. The results suggested that higher Frailty index was significantly associated with higher mortality risk. For every 0.01 increase in the index the […]
Adverse effects of antidepressants in younger adults
SSRIs might have higher rates of fracture than tricyclic antidepressants but lower mortality and adverse reactions. Carl Heneghan Antidepressants are commonly prescribed. Yet, in those under 65, there is scant evidence on the risks associated with their use. A recent publication in BMC looked at these risks in a cohort of 20 to 64-year […]
Falls and fractures with Z drugs
Z-drugs might be associated with an increased risk of fractures, falls, and injuries and their use should be considered in the context of overall risk of falls in an individual Carl Heneghan Zolpidem, zopiclone, eszopiclone and zaleplon, are known as the ‘Z-drugs’. They even have their own Wikipedia page. They are a group of […]
Crystalloids or saline?
Use of resuscitation fluids has largely been based on physiological principles rather than evidence. Carl Heneghan The debate over when to use crystalloids versus saline in unwell adults shows there has been considerable uncertainty about what to do in practice. Use of resuscitation fluids has largely been based on physiological principles rather than evidence. […]
Why I am confused about lung cancer screening
Should findings from a single trial inform decision making about lung cancer screening? Carl Heneghan, Editor in Chief A recent cost-effective analysis of low-dose computed tomography for lung cancer screening targeted in those at highest risk of lung cancer suggests only modest benefits. The conclusion is based on a cost-effectiveness analysis of risk-targeted screening […]
Evidence Watch: Implantable defibrillators might not affect death
Results of a recent review show a significant reduction in mortality with ICD. The effect, however, was weakened by the inclusion of the largest recent trial. Carl Heneghan, Editor in Chief One essential element of determining if a trial is sufficiently robust enough to believe the results is that the control group received standard […]