Cost-effectiveness modelling of percutaneous coronary interventions in stable coronary artery disease

Comparison of mean platelet volume levels in coronary artery ectasia and healthy people: systematic review and meta-analysis

Coronary artery ectasia (CAE) is defined as the dilation of a segment of a coronary vessel to at least 1.5 times the diameter of its normal adjacent segment. Mean platelet volume (MPV) plays a role in acute coronary syndromes, with high MPV correlating to poor prognosis for acute thrombotic events and CAE. Several studies investigated the relationship between MPV and CAE, resulting in conflicting results. These results led us to systematically review all studies investigating the relationship between MPV and ectatic heart diseases by performing a meta-analysis study in order to report a unified result. This meta-analysis study investigated all case-control articles examining the relationship between MPV and CAE. All studies in the following databases published until January 31, 2018, were investigated: Science Direct, Scopus, PubMed, Google Scholar, and Web of Science. Following a quality control evaluation, 14 articles, all of which were published following studies performed in Turkey from 2007 to 2016, met the criteria for study inclusion. After pooling the results from all of the articles, a total standardized mean difference (SMD) value of 0.584 (95% CI, 0.219, 0.95) was obtained using the D+L pooled SMD, indicating a significant difference (P=0.002) between the two groups, with higher MPV values in ectatic patients when comparing to healthy individuals. Therefore, increased MPV levels were significantly related to CAE, suggesting that platelets, with their inflammatory and thrombotic activities, play a role in this disease. Therefore, anti-platelet and anti-inflammatory therapies may be effective in treating CAE.

Na domhain shamhlaíochta: formulary submission guidelines in Ireland and the standards of normal science

In common with a number of other single payer health systems, Ireland, through the Health Information and Quality Authority, has established guidelines for formulary submissions by pharmaceutical manufacturers. In the last few months, however, there have been a number of questions raised as to whether or not guidelines for economic evaluations in such submissions are consistent with the standards of normal science. Do they require those making the submission to put their claims in the form of testable hypotheses that can support falsification and replication? The purpose of this commentary is to consider whether the 2014 guidelines meet these standards. The assessment presented argues that the guidelines do not meet the standards of normal science. Instead, from this perspective, they are best characterized as na domhain shamhlaíochta (imaginary or false worlds). There is no requirement in the guidelines for claims to be expressed as testable propositions, as hypotheses for expected impact that can be evaluated and the outcomes reported as part of ongoing disease area and therapeutic class reviews. The commentary concludes with suggestions for a reworking of the guidelines to meet the standards of normal science.