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 […]

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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 […]

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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 […]

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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 […]

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Do I need the drugs, doc? Heart failure drugs with preserved ejection fraction.

Evidence suggests heart failure patients with preserved ejection fraction could benefit from beta-blocker treatment, guidelines do not. Jack O’Sullivan   There is a well-established list of medications that work in heart failure with a reduced ejection fraction. However, it is unclear if these drugs are clinically effective in patients with heart failure with a preserved […]

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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. […]

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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 […]

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