Richard Lehman

Measuring brain natriuretic peptide in suspected left ventricular systolic dysfunction in general practice: cross-sectional study.

The prevalence of heart failure is increasing.1 Patients usually present to their general practitioner but a definitive diagnosis of left ventricular systolic dysfunction can only be achieved by cardiac imaging. Measuring plasma concentrations of brain natriuretic peptide has been advocated as a screening test that might reduce demands on cardiological services.2 We report the results of a community based study designed to investigate the effectiveness of measuring brain natriuretic peptide to diagnose left ventricular systolic dysfunction. The study was approved by the local research ethics committee. General practitioners were invited to refer patients with suspected heart failure to our clinic. The results of transthoracic echocardiography were reported by a single, experienced observer (IA). Ischaemia was diagnosed if Q waves, bundle branch block, T wave inversions, or left ventricular hypertrophy were present on an electrocardiogram. Evidence of heart failure on a chest radiograph was defined as the presence of pulmonary oedema or cardiomegaly. Concentrations of brain natriuretic peptide …

Choosing Wisely in the UK: the Academy of Medical Royal Colleges’ initiative to reduce the harms of too much medicine

A Malhotra and colleagues explain how and why a US initiative to get doctors to stop using interventions with no benefit is being brought to the UK

The most effective psychologically-based treatments to reduce anxiety and panic in patients with chronic obstructive pulmonary disease (COPD): a systematic review.

Chronic obstructive pulmonary disease (COPD) is irreversible and causes a progressive reduction in physical functioning. There is evidence that emotional distress contributes to loss of function and that improvements may be obtained via psychologically based interventions to alleviate anxiety and panic. This systematic review examined the most effective interventions to date. A literature search revealed 25 studies; these were assessed using standardised criteria for inclusion and quality. Six randomised, controlled trials fulfilled the criteria, but the variety of methods, interventions and measures prevented the use of a meta-analysis. Two studies were unpublished doctoral theses, four were published studies. All of the studies had one or more deficiencies; failure to measure or report lung function, large variation in attrition, lack of blinding in assessment of treatment outcome, lack of use of standardised anxiety measures. Description of the intervention was not always sufficient to allow replication. There were no trials of interventions aimed at reducing panic. No study was adequately designed to provide an assessment of psychological intervention aimed at anxiety in COPD. Secondary outcomes included impacts on breathlessness, disability and quality of life. It can be concluded that currently there is insufficient research of quality on which to base recommendations for effective interventions for anxiety and panic in COPD. Future research should tie the design of evaluation to interventions based on theories of the relationship between dyspnoea and anxiety.

The Importance of Clinical Trial Data Sharing Toward More Open Science

In cardiovascular medicine, as in all other medical disciplines, realizing the full value of clinical trial research data requires that the data be accessible to the research community and others who might be able to use them. Traditionally, the dissemination of knowledge derived from clinical research has been limited in scope: Investigators who have designed and conducted clinical trials make the decisions about which statistical analyses to conduct and then publish peer-reviewed articles to disseminate their findings. Clinical trial data are considered the property of the investigators and the entities that sponsored the research, with little or no opportunity for investigators external to the original study team to access the data. This traditional model is based on dissemination via print publication, the origins of which date back to the 17th century. By continued adherence to this model in the age of electronic knowledge exchange, our understanding of clinical interventions is limited by our lack of access to comprehensive data from all clinical trials in several ways. First, a select number of individuals decide which analyses to conduct, choosing some at the exclusion of others, while an analysis that might have been of great interest to another investigator (and which may have a direct bearing on clinical practice) may not be performed. Second, among these findings generated, a select number might be included in any peer-reviewed publication, leaving the research community and clinicians at a loss to know about findings generated but not disseminated. In fact, by comparing published articles with trial protocols, 50% of efficacy and 65% of harm outcomes per trial have been shown to be incompletely reported and biased toward the reporting of statistically significant findings.1 Third, among all trials conducted, there may be significant publication delays, as happened with the Ezetimibe and Simvastatin in Hypercholesterolemia …

Missing clinical trial data

A threat to the integrity of evidence based medicine

Tight control of blood glucose in long standing type 2 diabetes.

Reducing glycated haemoglobin below 7% is not supported by evidence and may even be harmful

A Historic Moment for Open Science: The Yale University Open Data Access Project and Medtronic

Two systematic reviews on rhBMP-2 in this issue are based on patient-level data from all clinical trials conducted by Medtronic, which were shared through the YODA Project—an unprecedented step in ...

Making evidence based medicine work for individual patients

Margaret McCartney and colleagues argue that new models of evidence synthesis and shared decision making are needed to accelerate a move from guideline driven care to individualised care

Open letter: European Medicines Agency should remove barriers to access clinical trial data

In an open letter to Guido Rasi, director of the European Medicines Agency, the AllTrials campaign urges the EMA to revise its trial data policy or risk losing the trust of patients and healthcare professionals

Cardiac impairment or heart failure

“Heart failure” confuses doctors and patients and needs renaming