Publications
126 results found
Howard J, Fisher L, Shun-Shin M, et al., 2019, Cardiac rhythm device identification using neural networks, JACC: Clinical Electrophysiology, Vol: 5, Pages: 576-586, ISSN: 2405-5018
BackgroundMedical staff often need to determine the model of a pacemaker or defibrillator (cardiac rhythm devices) quickly and accurately. Current approaches involve comparing a device’s X-ray appearance with a manual flow chart. We aimed to see whether a neural network could be trained to perform this task more accurately.Methods and ResultsWe extracted X-ray images of 1676 devices, comprising 45 models from 5 manufacturers. We developed a convolutional neural network to classify the images, using a training set of 1451 images. The testing set was a further 225 images, consisting of 5 examples of each model. We compared the network’s ability to identify the manufacturer of a device with those of cardiologists using a published flow-chart.The neural network was 99.6% (95% CI 97.5 to 100) accurate in identifying the manufacturer of a device from an X-ray, and 96.4% (95% CI 93.1 to 98.5) accurate in identifying the model group. Amongst 5 cardiologists using the flow-chart, median manufacturer accuracy was 72.0% (range 62.2% to 88.9%), and model group identification was not possible. The network was significantly superior to all of the cardiologists in identifying the manufacturer (p < 0.0001 against the median human; p < 0.0001 against the best human).ConclusionsA neural network can accurately identify the manufacturer and even model group of a cardiac rhythm device from an X-ray, and exceeds human performance. This system may speed up the diagnosis and treatment of patients with cardiac rhythm devices and it is publicly accessible online.
Hadjiphilippou SS, Cole G, Plymen C, 2019, Introduction of a multidisciplinary specialist heart failure team prevented 2 in 3 heart failure readmissions, Publisher: WILEY, Pages: 526-527, ISSN: 1388-9842
Arnold A, Shun-Shin M, Keene D, et al., 2018, His resynchronization versus biventricular pacing in patients with heart failure and left bundle branch block, Journal of the American College of Cardiology, Vol: 72, Pages: 3112-3122, ISSN: 0735-1097
Background His bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT).Objectives The authors performed a head-to-head, high-precision, acute crossover comparison between His bundle pacing and conventional biventricular CRT, measuring effects on ventricular activation and acute hemodynamic function.Methods Patients with heart failure and left bundle branch block referred for conventional biventricular CRT were recruited. Using noninvasive epicardial electrocardiographic imaging, the authors identified patients in whom His bundle pacing shortened left ventricular activation time. In these patients, the authors compared the hemodynamic effects of His bundle pacing against biventricular pacing using a high-multiple repeated alternation protocol to minimize the effect of noise, as well as comparing effects on ventricular activation.Results In 18 of 23 patients, left ventricular activation time was significantly shortened by His bundle pacing. Seventeen patients had a complete electromechanical dataset. In them, His bundle pacing was more effective at delivering ventricular resynchronization than biventricular pacing: greater reduction in QRS duration (−18.6 ms; 95% confidence interval [CI]: −31.6 to −5.7 ms; p = 0.007), left ventricular activation time (−26 ms; 95% CI: −41 to −21 ms; p = 0.002), and left ventricular dyssynchrony index (−11.2 ms; 95% CI: −16.8 to −5.6 ms; p < 0.001). His bundle pacing also produced a greater acute hemodynamic response (4.6 mm Hg; 95% CI: 0.2 to 9.1 mm Hg; p = 0.04). The incremental activation time reduction with His bundle pacing over biventricular pacing correlated with the incremental hemodynamic improvement with His bundle pacing over biventricular pacing (R = 0.70; p = 0.04).Conclusions His resynchronization delivers better ventricular resynchronization, and greater improvement in hemodynamic parameters, than biventricular pacing.
Sacchi S, Dhutia N, Shun-Shin MJ, et al., 2018, Doppler assessment of aortic stenosis: a 25-operator study demonstrating why reading the peak velocity is superior to velocity time integral, EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging, Vol: 19, Pages: 1380-1389, ISSN: 2047-2412
Aims Measurements with superior reproducibility are useful clinically and research purposes. Previous reproducibilitystudies of Doppler assessment of aortic stenosis (AS) have compared only a pair of observers and have notexplored the mechanism by which disagreement between operators occurs. Using custom-designed software whichstored operators’ traces, we investigated the reproducibility of peak and velocity time integral (VTI) measurementsacross a much larger group of operators and explored the mechanisms by which disagreement arose. ...................................................................................................................................................................................................Methodsand resultsTwenty-five observers reviewed continuous wave (CW) aortic valve (AV) and pulsed wave (PW) left ventricularoutflow tract (LVOT) Doppler traces from 20 sequential cases of AS in random order. Each operator unknowinglymeasured each peak velocity and VTI twice. VTI tracings were stored for comparison. Measuring the peak is muchmore reproducible than VTI for both PW (coefficient of variation 10.1 vs. 18.0%; P < 0.001) and CW traces (coeffi-cient of variation 4.0 vs. 10.2%; P < 0.001). VTI is inferior because the steep early and late parts of the envelope aredifficult to trace reproducibly. Dimensionless index improves reproducibility because operators tended to consistentlyover-read or under-read on LVOT and AV traces from the same patient (coefficient of variation 9.3 vs.17.1%; P < 0.001). ...................................................................................................................................................................................................Conclusion It is far more reproducible to measure the peak of a Doppler trace than the VTI, a strategy that reduces measurementvariance by approximately six-fold. Peak measurements are superior to VTI because tracing the steep slopesin th
Arnold AD, Shun-Shin MJ, Sohaib A, et al., 2018, Automated, high-precision echocardiographic and haemodynamic assessment of the effect of atrioventricular interval during right ventricular pacing in obstructed hypertrophic cardiomyopathy, European-Society-of-Cardiology Congress, Publisher: OXFORD UNIV PRESS, Pages: 729-729, ISSN: 0195-668X
Al-Lamee R, Howard JP, Shun-Shin MJ, et al., 2018, Fractional flow reserve and instantaneous wave-free ratio as predictors of the placebo-controlled response to percutaneous coronary intervention in stable single-vessel coronary artery disease: physiology-stratified analysis of ORBITA, Circulation, Vol: 138, Pages: 1780-1792, ISSN: 0009-7322
BACKGROUND : There are no data on how fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are associated with the placebo-controlled efficacy of percutaneous coronary intervention (PCI) in stable single-vessel coronary artery disease. METHODS : We report the association between prerandomization invasive physiology within ORBITA (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina), a placebo-controlled trial of patients who have stable angina with angiographically severe single-vessel coronary disease clinically eligible for PCI. Patients underwent prerandomization research FFR and iFR assessment. The operator was blinded to these values. Assessment of response variables, treadmill exercise time, stress echocardiography score, symptom frequency, and angina severity were performed at prerandomization and blinded follow-up. Effects were calculated by analysis of covariance. The ability of FFR and iFR to predict placebo-controlled changes in response variables was tested by using regression modeling. RESULTS : Invasive physiology data were available in 196 patients (103 PCI and 93 placebo). At prerandomization, the majority had Canadian Cardiovascular Society class II or III symptoms (150/196, 76.5%). Mean FFR and iFR were 0.69±0.16 and 0.76±0.22, respectively; 97% had ≥1 positive ischemia tests. The estimated effect of PCI on between-arm prerandomization-adjusted total exercise time was 20.7 s (95% confidence interval [CI], -4.0 to 45.5; P=0.100) with no interaction of FFR (Pinteraction=0.318) or iFR (Pinteraction=0.523). PCI improved stress echocardiography score more than placebo (1.07 segment units; 95% CI, 0.70-1.44; P<0.00001). The placebo-controlled effect of PCI on stress echocardiography score increased progressively with decreasing FFR (Pinteraction<0.00001) and
Sweeney M, Cole GD, Plymen CM, 2018, A case of bleomycin induced myocarditis, Publisher: WILEY, Pages: 170-170, ISSN: 1388-9842
Geindreau D, Pabari P, Cole G, et al., 2018, Aortic valve chordae tendineae causing aortic insufficiency and mimicking an aortic root dissection flap, JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY, Vol: 12, Pages: E11-E12, ISSN: 1934-5925
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Rajkumar CA, Nijjer SS, Cole GD, et al., 2018, Moving the goalposts into unblinded territory: lessons of DEFER and FAME 2 and their implications for shifting end points in ISCHEMIA, Circulation: Cardiovascular Quality and Outcomes, Vol: 11, ISSN: 1941-7705
At its conception, a randomized controlled trial is carefully designed to detect a significant effect of an intervention on a prespecified primary end point. Each aspect of a trial is deliberately constructed to allow it to answer this principal question. From the moment the first patient is recruited, the primary end point is fixed, and all other outcomes are considered secondary.
Shun-Shin M, Cole G, Dhutia N, et al., 2017, The development of automated methods for the reproducible assessment of aortic stenosis, Publisher: OXFORD UNIV PRESS, Pages: 489-489, ISSN: 0195-668X
Zaman S, Zaman S, Scholtes T, et al., 2017, The mortality risk of deferring optimal medical therapy in heart failure: a systematic comparison against norms for surgical consent and patient information leaflets, European Journal of Heart Failure, Vol: 19, Pages: 1401-1409, ISSN: 1879-0844
Aims: The prescription of optimal medical therapy for heart failure is often delayed despite compelling evidence of the reductions in mortality it may facilitate. We calculated the absolute risk resulting from delayed prescription of therapy. For comparison, we established the threshold applied by clinicians when discussing the risk for death associated with an intervention, and the threshold used in of ficial patient information leaflets.Methods and results:We undertook a meta-analysis of randomized controlled trials to calculate the excess mortality caused by deferral of medical therapy for 1 year. Risk ratios for angiotensin-converting enzyme inhibitors, beta-blockers and aldosterone antagonists were 0.80, 0.73 and 0.77, respectively. In patients who might achieve a 1-year survival rate of 90% if treated, a 1-year deferral of treatment reduced survival to 78% (i.e. an annual absolute increase in mortality of 12 in 100 patients). This corresponds to an additional absolute mortality risk per month of 1%. A survey of clinicians carried out to establish the risk threshold at which they would obtain written consent showed the majority (85%) sought written consent for interventions associated with a 12-fold lower mortality risk: one in 100 patients. A systematic review of UK patient information leaflets to establish the magnitude of risk considered sufficient to be stated explicitly showed that leaflets begin to mention death at a ∼18 000-fold lower mortality risk of just 0.0007 in 100 patients.Conclusions:Deferring heart failure treatment for 1 year carries far greater risk than the level at which most doctors seek written consent, and 18000 times more risk than the level at which patient information leaflets begin to mention death.
Shun-Shin MJ, Zheng S, Cole G, et al., 2017, Implantable cardioverter defibrillators for primary prevention of death in left ventricular dysfunction with and without ischaemic heart disease: a meta-analysis of 8567 patients in the 11 trials, European Heart Journal, Vol: 38, Pages: 1738-1746, ISSN: 1522-9645
AimsPrimary prevention implantable cardioverter defibrillators (ICDs) are established therapy for reducing mortality in patients with left ventricular systolic dysfunction and ischaemic heart disease (IHD). However, their efficacy in patients without IHD has been controversial. We undertook a meta-analysis of the totality of the evidence.Methods We systematically identified all RCTs comparing ICD versus no ICD in primary prevention. Eligible RCTs were those that recruited patients with left ventricular dysfunction, reported all-cause mortality, and presented their results stratified by the presence of IHD (or recruited only those with or without). Our primary endpoint was all-cause mortality.ResultsWe identified 11 studies enrolling 8567 participants with left ventricular dysfunction, including 3128 patients without IHD and 5439 patients with IHD. In patients without IHD, ICD therapy reduced mortality by 24% (HR 0.76, 95% CI 0.64 to 0.90 p=0.001). In patients with IHD, ICD implantation (at a dedicated procedure), also reduced mortality by 24% (HR 0.76, 95% CI 0.60 to 0.96, p=0.02).ConclusionsUntil now, it has never been explicitly stated that the patients without IHD in COMPANION showed significant survival benefit from adding ICD therapy (to a background of CRT). Furthermore, even with only the trials before DANISH, meta-analysis shows reduced mortality. DANISH is consistent with these data.With a significant 24% mortality reduction in both aetiologies, it may no longer be necessaryto distinguish between them when deciding on primary prevention ICD implantation.
Zolgharni M, Negoita M, Dhutia NM, et al., 2017, Automatic detection of end-diastolic and end-systolic frames in 2D echocardiography, ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES, Vol: 34, Pages: 956-967, ISSN: 0742-2822
Background:Correctly selecting the end-diastolic and end-systolic frames on a 2D echocardiogram is important and challenging, for both human experts and automated algorithms. Manual selection is time-consuming and subject to uncertainty, and may affect the results obtained, especially for advanced measurements such as myocardial strain.Methods and Results:We developed and evaluated algorithms which can automatically extract global and regional cardiac velocity, and identify end-diastolic and end-systolic frames. We acquired apical four-chamber 2D echocardiographic video recordings, each at least 10 heartbeats long, acquired twice at frame rates of 52 and 79 frames/s from 19 patients, yielding 38 recordings. Five experienced echocardiographers independently marked end-systolic and end-diastolic frames for the first 10 heartbeats of each recording. The automated algorithm also did this. Using the average of time points identified by five human operators as the reference gold standard, the individual operators had a root mean square difference from that gold standard of 46.5 ms. The algorithm had a root mean square difference from the human gold standard of 40.5 ms (P<.0001). Put another way, the algorithm-identified time point was an outlier in 122/564 heartbeats (21.6%), whereas the average human operator was an outlier in 254/564 heartbeats (45%).Conclusion:An automated algorithm can identify the end-systolic and end-diastolic frames with performance indistinguishable from that of human experts. This saves staff time, which could therefore be invested in assessing more beats, and reduces uncertainty about the reliability of the choice of frame.
Cole G, Sacchi S, Dhutia N, et al., 2017, DOPPLER ASSESSMENT OF AORTIC STENOSIS: READING THE PEAK VELOCITY IS SUPERIOR TO VELOCITY TIME INTEGRAL, Annual Conference of the British-Cardiovascular-Society (BCS), Publisher: BMJ PUBLISHING GROUP, Pages: A93-A93, ISSN: 1355-6037
Dhutia NM, Zolgharni M, Mielewczik M, et al., 2017, Open-source, vendor-independent, automated multi-beat tissue Doppler echocardiography analysis, International Journal of Cardiovascular Imaging, Vol: 33, Pages: 1135-1148, ISSN: 1569-5794
Current guidelines for measuring cardiac function by tissue Doppler recommend using multiple beats, but this has a time cost for human operators. We present an open-source, vendor-independent, drag-and-drop software capable of automating the measurement process. A database of ~8000 tissue Doppler beats (48 patients) from the septal and lateral annuli were analyzed by three expert echocardiographers. We developed an intensity- and gradient-based automated algorithm to measure tissue Doppler velocities. We tested its performance against manual measurements from the expert human operators. Our algorithm showed strong agreement with expert human operators. Performance was indistinguishable from a human operator: for algorithm, mean difference and SDD from the mean of human operators’ estimates 0.48 ± 1.12 cm/s (R2 = 0.82); for the humans individually this was 0.43 ± 1.11 cm/s (R2 = 0.84), −0.88 ± 1.12 cm/s (R2 = 0.84) and 0.41 ± 1.30 cm/s (R2 = 0.78). Agreement between operators and the automated algorithm was preserved when measuring at either the edge or middle of the trace. The algorithm was 10-fold quicker than manual measurements (p < 0.001). This open-source, vendor-independent, drag-and-drop software can make peak velocity measurements from pulsed wave tissue Doppler traces as accurately as human experts. This automation permits rapid, bias-resistant multi-beat analysis from spectral tissue Doppler images.
Ahmad Y, Sen S, Nijjer S, et al., 2016, Thrombus Aspiration does not Reduce Mortality in STEMI Patients: A Meta-Analysis of 20,192 Patients, with Implications for Future Trial Design, Annual Conference of the British Cardiovascular Society (BCS) on Prediction and Prevention, Publisher: BMJ Publishing Group, Pages: A24-A25, ISSN: 1355-6037
Negoita M, Zolgharni M, Dadkho E, et al., 2016, Frame rate required for speckle tracking echocardiography: A quantitative clinical study with open-source, vendor-independent software, International Journal of Cardiology, Vol: 218, Pages: 31-36, ISSN: 1874-1754
ObjectivesTo determine the optimal frame rate at which reliable heart walls velocities can be assessed by speckle tracking.BackgroundAssessing left ventricular function with speckle tracking is useful in patient diagnosis but requires a temporal resolution that can follow myocardial motion. In this study we investigated the effect of different frame rates on the accuracy of speckle tracking results, highlighting the temporal resolution where reliable results can be obtained.Material and methods27 patients were scanned at two different frame rates at their resting heart rate. From all acquired loops, lower temporal resolution image sequences were generated by dropping frames, decreasing the frame rate by up to 10-fold.ResultsTissue velocities were estimated by automated speckle tracking. Above 40 frames/s the peak velocity was reliably measured. When frame rate was lower, the inter-frame interval containing the instant of highest velocity also contained lower velocities, and therefore the average velocity in that interval was an underestimate of the clinically desired instantaneous maximum velocity.ConclusionsThe higher the frame rate, the more accurately maximum velocities are identified by speckle tracking, until the frame rate drops below 40 frames/s, beyond which there is little increase in peak velocity. We provide in an online supplement the vendor-independent software we used for automatic speckle-tracked velocity assessment to help others working in this field.
Francis DP, Cole GD, 2016, Authors' reply to Perry., BMJ, Vol: 353, Pages: i2031-i2031, ISSN: 0959-8138
Francis DP, Cole GD, 2016, Coronary artery disease: screen or treat?, BMJ, Vol: 352, ISSN: 0959-8138
Finegold JA, Shun-Shin M, Cole G, et al., 2016, The distribution of lifespan gain from primary prevention intervention, Open Heart, Vol: 3, ISSN: 2053-3624
Objective: When advising patients about possible initiation of primary prevention treatment, clinicians currently do not have information on expected impact on lifespan, nor how much this increment differs between individuals. Methods: First, UK cardiovascular and non-cardiovascular mortality data was used to calculate the mean lifespan gain from an intervention (such as a statin) that reduces cardiovascular mortality by 30%. Second, a new method was developed to calculate the probability distribution of lifespan gain. Third, we performed a survey in 3 UK cities on 11 days between May-June 2014 involving 396 participants (mean age 40 years, 55% male) to assess how individuals evaluate potential benefit from primary prevention therapies. Results: Amongst numerous identical patients the lifespan gain, from an intervention that reduces cardiovascular mortality by 30%, is concentrated within an unpredictable minority. For example, 50-year-old males with national-average cardiovascular risk have mean lifespan gain of 7 months. However, 93% of these identical individuals gain no lifespan, while the remaining 7% gain a mean of 99 months. Many survey respondents preferred a chance of large lifespan gain to the identical life-expectancy gain given as certainty. Indeed, 33% preferred a 2% probability of 10 years to 5-fold more gain, expressed as certainty of 1 year. Conclusions:People who gain lifespan from preventative therapy gain far more than the average for their risk stratum, even if perfectly defined. This may be important in patient decision-making. Looking beyond mortality reduction alone from preventative therapy, the benefits are likely to be even larger.
Ahmad Y, Sen S, Keene D, et al., 2015, Thrombus aspiration does not reduce mortality in STEMI patients: a meta-analysis of 20,192 patients, with implications for future trial design, 27th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B103-B104, ISSN: 0735-1097
Ahmad Y, Sen S, Shun-Shin M, et al., 2015, Intra-aortic balloon pump therapy does not reduce mortality in acute myocardial infarction, with or without cardiogenic shock: application of a baseline inequality index to account for differential outcomes in randomized and observational studies, 27th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B103-B103, ISSN: 0735-1097
Cole GD, Nowbar AN, Mielewczik M, 2015, Frequency of discrepancies in retracted clinical trial reports versus unretracted reports: blinded case-control study (vol 351, pg h4708, 2015), BMJ-BRITISH MEDICAL JOURNAL, Vol: 351, ISSN: 1756-1833
Cole GD, Nowbar A, Mielewczik M, et al., 2015, Frequency of discrepancies in retracted clinical trial reports versus unretracted reports: blinded case-control study, British Medical Journal, Vol: 351, ISSN: 1468-5833
Objectives To compare the frequency of discrepancies in retracted reports of clinical trials with those in adjacent unretracted reports in the same journal.Design Blinded case-control study.Setting Journals in PubMed.Population 50 manuscripts, classified on PubMed as retracted clinical trials, paired with 50 adjacent unretracted manuscripts from the same journals. Reports were randomly selected from PubMed in December 2012, with no restriction on publication date. Controls were the preceding unretracted clinical trial published in the same journal. All traces of retraction were removed. Three scientists, blinded to the retraction status of individual reports, reviewed all 100 trial reports for discrepancies. Discrepancies were pooled and cross checked before being counted into prespecified categories. Only then was the retraction status unblinded for analysis.Main outcome measure Total number of discrepancies (defined as mathematically or logically contradictory statements) in each clinical trial report.Results Of 479 discrepancies found in the 100 trial reports, 348 were in the 50 retracted reports and 131 in the 50 unretracted reports. On average, individual retracted reports had a greater number of discrepancies than unretracted reports (median 4 (interquartile range 2-8.75) v 0 (0-5); P<0.001). Papers with a discrepancy were significantly more likely to be retracted than those without a discrepancy (odds ratio 5.7 (95% confidence interval 2.2 to 14.5); P<0.001). In particular, three types of discrepancy arose significantly more frequently in retracted than unretracted reports: factual discrepancies (P=0.002), arithmetical errors (P=0.01), and missed P values (P=0.02). Results from a retrospective analysis indicated that citations and journal impact factor were unlikely to affect the result.Conclusions Discrepancies in published trial reports should no longer be assumed to be unimportant. Scientists, blinded to retraction status and with no specialist skill
Cole GD, Francis DP, 2015, Trials are best, ignore the rest: safety and efficacy of digoxin., BMJ, Vol: 351
Cole GD, Dhutia NM, Shun-Shin MJ, et al., 2015, Defining the real-world reproducibility of visual grading and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation., International Journal of Cardiovascular Imaging, Vol: 31, Pages: 1303-1314, ISSN: 1569-5794
Left ventricular function can be evaluated by qualitative grading and by eyeball estimation of ejection fraction (EF). We sought to define the reproducibility of these techniques, and how they are affected by image quality, experience and accreditation. Twenty apical four-chamber echocardiographic cine loops (Online Resource 1–20) of varying image quality and left ventricular function were anonymized and presented to 35 operators. Operators were asked to provide (1) a one-phrase grading of global systolic function (2) an “eyeball” EF estimate and (3) an image quality rating on a 0–100 visual analogue scale. Each observer viewed every loop twice unknowingly, a total of 1400 viewings. When grading LV function into five categories, an operator’s chance of agreement with another operator was 50 % and with themself on blinded re-presentation was 68 %. Blinded eyeball LVEF re-estimates by the same operator had standard deviation (SD) of difference of 7.6 EF units, with the SD across operators averaging 8.3 EF units. Image quality, defined as the average of all operators’ assessments, correlated with EF estimate variability (r = −0.616, p < 0.01) and visual grading agreement (r = 0.58, p < 0.01). However, operators’ own single quality assessments were not a useful forewarning of their estimate being an outlier, partly because individual quality assessments had poor within-operator reproducibility (SD of difference 17.8). Reproducibility of visual grading of LV function and LVEF estimation is dependent on image quality, but individuals cannot themselves identify when poor image quality is disrupting their LV function estimate. Clinicians should not assume that patients changing in grade or in visually estimated EF have had a genuine clinical change.
Cole GD, Shun-Shin MJ, Nowbar AN, et al., 2015, Difficulty in detecting discrepancies in a clinical trial report:260-reader evaluation, International Journal of Epidemiology, Vol: 44, Pages: 862-869, ISSN: 1464-3685
Background: Scientific literature can contain errors. Discrepancies, defined as two or more statements or results that cannot both be true, may be a signal of problems with a trial report. In this study, we report how many discrepancies are detected by a large panel of readers examining a trial report containing a large number of discrepancies.Methods: We approached a convenience sample of 343 journal readers in seven countries, and invited them in person to participate in a study. They were asked to examine the tables and figures of one published article for discrepancies. 260 participants agreed, ranging from medical students to professors. The discrepancies they identified were tabulated and counted. There were 39 different discrepancies identified. We evaluated the probability of discrepancy identification, and whether more time spent or greater participant experience as academic authors improved the ability to detect discrepancies.Results: Overall, 95.3% of discrepancies were missed. Most participants (62%) were unable to find any discrepancies. Only 11.5% noticed more than 10% of the discrepancies. More discrepancies were noted by participants who spent more time on the task (Spearman’s ρ = 0.22, P < 0.01), and those with more experience of publishing papers (Spearman’s ρ = 0.13 with number of publications, P = 0.04).Conclusions: Noticing discrepancies is difficult. Most readers miss most discrepancies even when asked specifically to look for them. The probability of a discrepancy evading an individual sensitized reader is 95%, making it important that, when problems are identified after publication, readers are able to communicate with each other. When made aware of discrepancies, the majority of readers support editorial action to correct the scientific record.
Ahmad Y, Sen S, Shun-Shin MJ, et al., 2015, Intra-aortic Balloon Pump Therapy for Acute Myocardial Infarction AMeta-analysis, JAMA INTERNAL MEDICINE, Vol: 175, Pages: 931-939, ISSN: 2168-6106
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Cole GD, Shun-Shin MJ, Finegold JA, et al., 2015, Grateful receipt of clarifications on a perioperative trial: An illustration of the duty of readers to ask questions, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 179, Pages: 507-509, ISSN: 0167-5273
Saura Espin D, Caballero Jimenez L, Oliva Sandoval M, et al., 2014, Oral Abstract session: Demanding measurements: why bother? Thursday 4 December 2014, 16:30-18:00Location: Agora., Eur Heart J Cardiovasc Imaging, Vol: 15 Suppl 2, Pages: ii65-ii67
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