Editors’ Review of BMJ EBM’s Analysis of Cochrane’s HPV Systematic Review 

     On 27 July 2018, BMJ EBM published an analysis [1] that outlined problems with Cochrane’s systematic review of human papillomavirus (HPV) vaccine, which we shall refer to as the Cochrane HPV Review, published in May 2018; this included missing eligible trials, reporting bias, and biased trial designs and conflicts of interest. [2,3] In […]

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TVT: seventeen year follow up and the shrinking denominator effect

  The shrinking denominator enhances the effect size and misleads the reader into thinking the effect is better than it actually is. Carl Heneghan I am at the Ideal Conference, at a workshop talking about clinical trial reporting and recent surgical scandals.  I chose the 17 years follow-up of the Tension-free Vaginal Tape – often quoted – […]

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Do Calcium and Vitamin D supplements cause cancer?

  In a recent trial calcium and vitamin D treatment elevated the risk of precancerous polyps nearly fourfold – but does this result matter?  Carl Heneghan If you weren’t observing carefully, you likely missed this study, I did. A recent randomised trial participants with one or more adenomas received daily calcium, vitamin D3, both or […]

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NOACs: good for some perhaps, but not for all

  ‘More than ten years of use, there remains uncertainty as to which populations are most likely to benefit from NOACs.’ Kamal Mahtani Over the last ten years, prescribing of non-vitamin K oral anticoagulants (NOACs) has increased substantially. In the UK, an estimated 58% increase has been quoted with a nine-fold increase in anticoagulant costs. […]

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Should you treat resolved Atrial Fibrillation?

  Do patients with resolved AF have a higher risk of strokes, asks Jack O’Sullivan Patients with Atrial Fibrillation (AF) are five times more likely to have a stroke than patients without AF. AF can be reversed (sinus rhythm restored) via catheter ablation or cardioversion (either electrical or chemical). Patients can also spontaneously revert to sinus […]

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Overestimation of cardiovascular risk and what to do about it

  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 […]

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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 […]

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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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