{"id":1636,"date":"2018-02-15T18:51:46","date_gmt":"2018-02-15T18:51:46","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/?p=1636"},"modified":"2018-02-15T20:38:36","modified_gmt":"2018-02-15T20:38:36","slug":"evidence-watch-carl-heneghans-view-evidence-impacts-practice","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/02\/15\/evidence-watch-carl-heneghans-view-evidence-impacts-practice\/","title":{"rendered":"Evidence Watch: Carl Heneghan&#8217;s selection of evidence that impacts on practice"},"content":{"rendered":"<p>&nbsp;<\/p>\n<p><em>This week&#8217;s Evidence Watch highlights the risk of pre-eclampsia with metformin, the role of repeated influenza vaccination, de-prescribing medications and assessing harms in the elderly at the time of elective surgery.<\/em><\/p>\n<p style=\"text-align: right\">Carl Heneghan, Editor in Chief<\/p>\n<hr \/>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1610 alignright\" src=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/01\/Picture1-2.png\" alt=\"\" width=\"277\" height=\"143\" \/><\/p>\n<p>A <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29044702\">meta-analysis<\/a> evaluating the risk of pre-eclampsia in women taking metformin before, or during pregnancy found that there was no difference in risk compared to placebo. [1] But compared to insulin showed a reduced risk. The question remains as to whether metformin is protective or insulin harmful.<\/p>\n<p>Does repeated influenza vaccination prevent severe influenza infection? <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29311098\">This case-control study<\/a> published in the <strong><em>Canadian Medical Association Journal<\/em><\/strong> suggests it does. [2] I can\u2019t help thinking there is a lack of randomised trial in this area to inform decision making: using case-control methods to inform policy would be a retrograde step.<\/p>\n<p>A <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29321031\">pragmatic cluster RCT<\/a> in 46 general practices in the Netherlands attempted to deprescribe preventive cardiovascular medications in those where the risks outweighed the potential benefits of treatment. [3] In the intervention group 65% quit their medications, and at 2 years 27% were still not taking them. Predicted CVD risk increased by 2% in the intervention group compared to 1.9% in the usual care group, although BP rose by 6mmHg in the intervention group, suggesting not all folk should have their meds stopped.<\/p>\n<p>Elective surgery can cause significant harm to older adults. This <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29325567\">systematic review<\/a>, in BMC Medicine. highlights the prognostic factors to watch out for at the time of surgery. [4] The review identified 44 studies (12,281 patients) and found that frailty, cognitive impairment, smoking and depression were associated with post-op complications whereas age per se was not.<\/p>\n<p>References<\/p>\n<p>[1] <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29044702\">Risk of pre-eclampsia in women taking metformin<\/a>: a systematic review and meta-analysis.\u00a0Alqudah A. et al.\u00a02018.\u00a0<em>Diabetic Medicine: A Journal of the British Diabetic Association<\/em>,\u00a0<em>35<\/em>(2),\u00a0160\u2013172.<\/p>\n<p>[2] <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29311098\">Repeated influenza vaccination for preventing severe and fatal influenza infection in older adults<\/a>: A multicentre case-control study.\u00a0Casado I. et al.\u00a0\u00a0CMAJ.\u00a02018 Jan 8;190(1):E3-E12. doi: 10.1503\/cmaj.170910<\/p>\n<p>[3] <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29321031\">Deprescribing preventive cardiovascular medication in patients with predicted low cardiovascular disease risk in general practice<\/a> &#8211; the ECSTATIC study: A cluster randomised non-inferiority trial.\u00a0Luymes C.H. et al.\u00a02018.\u00a0<em>BMC Medicine<\/em>,\u00a0<em>16<\/em>(1),\u00a05.<\/p>\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29325567\">[4] Identifying older adults at risk of harm following elective surgery: A systematic review and meta-analysis.\u00a0<\/a>Watt J. et al.\u00a02018.\u00a0<em>BMC Medicine<\/em>,\u00a0<em>16<\/em>(1),\u00a02.<\/p>\n<hr \/>\n<p><a href=\"http:\/\/ebm.bmj.com\/\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1611 alignleft\" src=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/01\/Picture3.png\" alt=\"\" width=\"215\" height=\"286\" \/><\/a>BMJ <a href=\"http:\/\/ebm.bmj.com\/\">Evidence-Based Medicine<\/a> &#8211;\u00a0original evidence-based research, insights and opinions on what matters for health care.<\/p>\n<p>BMJ EBM accepts submissions of a wide range of article types, including original research, debate, analysis &amp; opinion, and clinical spotlight.<\/p>\n<p>We select from over 100 journals reliable and useful evidence summarised in <a href=\"http:\/\/ebm.bmj.com\/\">BMJ Evidence-Based Medicine<\/a>.<\/p>\n<p>Read more about BMJ EBM content in the\u00a0<a href=\"http:\/\/ebm.bmj.com\/content\/early\/2018\/01\/24\/bmjebm-2018-110906\">Welcome to BMJ Evidence-Based Medicine Editorial<\/a>.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>Carl Heneghan is<a href=\"http:\/\/www.phc.ox.ac.uk\/team\/researchers\/carl-heneghan\">\u00a0Professor of EBM<\/a>\u00a0at the University of Oxford,<a href=\"http:\/\/www.cebm.net\/\">\u00a0Director of CEBM<\/a>\u00a0and Editor in Chief of BMJ EBM<\/p>\n<p><em>Follow on twitter\u00a0<a href=\"https:\/\/twitter.com\/carlheneghan?lang=en\">@carlheneghan<\/a><\/em><\/p>\n<p><b>Competing interests<\/b><\/p>\n<p>Carl has received expenses and fees for his media work including BBC Inside Health. He holds grant funding from the NIHR, the NIHR School of Primary Care Research, The Wellcome Trust and the WHO. He has also received income from the publication of a series of toolkit books published by Blackwells. CEBM jointly runs the\u00a0<a title=\"\" href=\"http:\/\/evidencelive.org\/\">EvidenceLive<\/a>\u00a0Conference with the BMJ and the\u00a0<a title=\"\" href=\"http:\/\/www.preventingoverdiagnosis.net\/\">Overdiagnosis Conference<\/a>\u00a0with some international partners which are based on a\u00a0 non-profit model.<strong>\u00a0<\/strong><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp; This week&#8217;s Evidence Watch highlights the risk of pre-eclampsia with metformin, the role of repeated influenza vaccination, de-prescribing medications and assessing harms in the elderly at the time of elective surgery. Carl Heneghan, Editor in Chief A meta-analysis evaluating the risk of pre-eclampsia in women taking metformin before, or during pregnancy found that there [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/02\/15\/evidence-watch-carl-heneghans-view-evidence-impacts-practice\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":1619,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14374,14388],"tags":[],"class_list":["post-1636","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-carl-heneghan","category-evidence-watch"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Evidence Watch: Carl Heneghan&#039;s selection of evidence that impacts on practice - BMJ EBM Spotlight<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/02\/15\/evidence-watch-carl-heneghans-view-evidence-impacts-practice\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Evidence Watch: Carl Heneghan&#039;s selection of evidence that impacts on practice - BMJ EBM Spotlight\" \/>\n<meta property=\"og:description\" content=\"&nbsp; This week&#8217;s Evidence Watch highlights the risk of pre-eclampsia with metformin, the role of repeated influenza vaccination, de-prescribing medications and assessing harms in the elderly at the time of elective surgery. Carl Heneghan, Editor in Chief A meta-analysis evaluating the risk of pre-eclampsia in women taking metformin before, or during pregnancy found that there [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/02\/15\/evidence-watch-carl-heneghans-view-evidence-impacts-practice\/\" \/>\n<meta property=\"og:site_name\" content=\"BMJ EBM Spotlight\" \/>\n<meta property=\"article:published_time\" content=\"2018-02-15T18:51:46+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2018-02-15T20:38:36+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/01\/Picture1-2.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"380\" \/>\n\t<meta property=\"og:image:height\" content=\"250\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/02\\\/15\\\/evidence-watch-carl-heneghans-view-evidence-impacts-practice\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/02\\\/15\\\/evidence-watch-carl-heneghans-view-evidence-impacts-practice\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Evidence Watch: Carl Heneghan&#8217;s selection of evidence that impacts on practice\",\"datePublished\":\"2018-02-15T18:51:46+00:00\",\"dateModified\":\"2018-02-15T20:38:36+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/02\\\/15\\\/evidence-watch-carl-heneghans-view-evidence-impacts-practice\\\/\"},\"wordCount\":550,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/02\\\/15\\\/evidence-watch-carl-heneghans-view-evidence-impacts-practice\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/files\\\/2018\\\/01\\\/Picture1-2.jpg\",\"articleSection\":[\"Carl Heneghan\",\"Evidence Watch\"],\"inLanguage\":\"en-GB\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/02\\\/15\\\/evidence-watch-carl-heneghans-view-evidence-impacts-practice\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjebmspotlight\\\/2018\\\/02\\\/15\\\/evidence-watch-carl-heneghans-view-evidence-impacts-practice\\\/\",\"name\":\"Evidence Watch: Carl Heneghan's selection of evidence that impacts on practice - 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