A New Zealand study sets new standards for predicting cardiovascular risk and questions the validity of pre-existing risk equations Carl Heneghan Prevention of cardiovascular disease relies on identifying those most at risk. Most cohorts of patients were established many years ago with patients at higher risk. A recent prospective cohort study done in New Zealand representing primary care […]
Category: Evidence Watch
Diagnosing childhood coeliac disease without biopsy
Can a diagnosis of coeliac disease in children be made without doing a biopsy? Annette Pluddemann Current NICE guidelines recommend that in children referred with a positive serological test result, further investigations to rule in or rule out coeliac disease may use combinations of IgA EMA serological testing, HLA genetic testing and endoscopic biopsy. […]
Too much medicine: Oxygen not for acute stroke
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 […]
Undertreatment of mitral regurgitation
“All evidence, especially our lifelong population-based data, point towards a substantial unmet need for treatment of mitral regurgitation.” Jack O’Sullivan Despite being the most common heart valvular disease, it is unclear how often patients with mitral regurgitation are treated. This is concerning because early treatment is beneficial [1]. A recent study, published in the […]
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 […]
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 […]