Clin Med
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Randomised controlled trials are the gold standard for testing the efficacy and safety of health interventions, especially medications, and researchers in the U. K. are required to gain approval from ethics committees, the regulatory body (Medicines and Healthcare products Regulatory Agency) and local NHS research governance departments for such trials. ⋯ K. and to the NHS's ability to deliver high-quality evidence on which doctors can base clinical decisions and improve the delivery of care. This article discusses recent experience of running large-scale clinical trials and suggests measures that could improve the current situation.
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Surgery offers good results for patients with significant valvular heart disease. Valve replacement and repair are the main surgical options. Older patients and redo procedures are increasingly frequent.
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The Federation of Royal Colleges of Physicians of the U. K. has developed a programme to deliver specialty certificate examinations. These are knowledge-based examinations to be passed by all senior trainees in most medical specialties seeking a Certificate of Completion of Training (CCT). ⋯ The evidence so far suggests that though reasonable reliability (reproducibility) can be achieved, validity (testing what is intended) may be lacking. Educational impact, cost effectiveness, and acceptability require more evidence. Consistency in standard setting is difficult.
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Iron-deficiency anaemia (IDA) is often inappropriately investigated. This study aimed to improve referrals, estimate cost implications and determine effectiveness of referral criteria for diagnosing cancer. Patients referred for investigation of anaemia were studied. ⋯ Fourteen of 112 patients with IDA had cancer versus 4/109 non-IDA (p < 0.025), overall prevalence 8.1%. Many referrals for anaemia investigation are inappropriate and a 35% reduction was achieved. The sensitivity and negative predictive value of the referral criteria for diagnosing gastrointestinal cancer were 77.8% and 96.3% respectively.