Blog entry by Arif Khwaja
Anyone who has been to a GKA masterclass will know that a key learning message from Professor El Nahas' session on 'how to read a paper' is to assess whether the findings are relevant to your healthcare setting. I was thinking about this recently when a large RCT was recently published in NEJM evaluating whether low molecular weight heparin reduces mortality in acutely ill medical patients- this was of interest as in the UK we are aggressively audited to make sure all acute admissions get prophylactic heparin. The outcome of this trial of more than 8000 patients was negative but what interested me was where the trial was conducted - China, India, Korea, Malaysia, Mexico, the Philippines, and Tunisia. One question that arises is how applicable this data would be to say a Uk setting? We know that in the UK there are huge variations in outcome for the same diseases in different hospitals- despite that fact that we have only one major supplier of healthcare - the NHS. So I imagine both care and patient characteristics maybe very different ( not better or worse just different) in the UK than say Tunisia. Similarly in two trials of belimumab in SLE the BLISS 52 trial reported relatively positive outcomes whilst BLISS 76 seemed to suggest that belimumab had a more marginal effect. Some have suggested that this was because BLISS 76 was conducted predominantly in the USA and Europe whilst Bliss 52 was conducted predominantly in Asia and Eastern Europe - the implication being that either the disease itself or standard care is different between say the USA and Asia My own thoughts are that all we can do is look at data and critically evaluate the relevance to the healthcare setting we practice in. Of course it also suggests that we all have a responsibility to try if possible to get involved in clinical research conducted in line with good clinical practice to ensure evidence-based decision making continues to develop.
See : http://www.nejm.org/doi/full/10.1056/NEJMoa1111288?query=TOC