Clinical alerts have an immediate effect on medical practice

A recent study shows that disseminating the results of clinical trials before publication in peer-reviewed journals can change medical practice promptly and significantly.

By | December 14, 2000

Disseminating the results of clinical trials before publication in peer-reviewed journals can change medical practice promptly and significantly, Gross et al report in the 13 December issue of Journal of the American Medical Association (JAMA 2000 284:2886-2893).

Dr Cary Gross and colleagues from the Yale University School of Medicine looked into the practical impact of two carotid endarterectomy (CEA) trials, the results of which were disseminated by means of the National Institutes of Health clinical alerts before publication.

The monthly carotid endarterectomy (CEA) rate in seven US States was recorded from 1989 — two years before the first clinical alert — to 1996, two years after the second clinical alert. After the first clinical alert, the CEA rate increased by 3.4% per month during the following six months. After the results were published in a peer-reviewed journal, the monthly increase in the CEA rate was only 0.5%. For the second trial, the CEA rate increased by 7.3% per month in the first seven months after clinical alerts; after journal publication the monthly rate decreased by 0.44%.

The authors point out that because of pre-publication clinical alerts, trial results are sometimes applied to patients and settings not directly supported by the trials. A combination of fast-track peer-review and prompt internet publication of full-length peer-reviewed articles may be a solution to the problem.

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