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Cooling Therapy for Stroke: Evidence and Efficacy Analysis

This study delves into the effectiveness of cooling therapy for stroke patients, analyzing experimental data and clinical trials to determine treatment power, evidence quality, publication bias, and conditions for maximum efficacy. Findings suggest promising results in animal studies and encouraging evidence from clinical trials. The research also explores biases in reporting and the importance of transparent analysis, aiming to enhance future research design and improve treatment outcomes.

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Cooling Therapy for Stroke: Evidence and Efficacy Analysis

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  1. Evidence based translational medicine Experimental Studies Clinical trial • Systematic review and meta-analysis • how powerful is the treatment? • what is the quality of evidence? • what is the range of evidence? • is there evidence of a publication bias? • What are the conditions of maximum efficacy?

  2. Cooling for stroke • Cooling seems to work in patients who have brain injury due to cardiac arrest • There’s lots of stories about individual patients who should have extensive brain damage but don’t • Many labs use cooling as a positive control in their animal studies • Preliminary evidence from clinical trials in stroke is encouraging

  3. How powerful is the treatment in animals? • 101 publications • 222 experiments • 3256 animals 43.5% protection (40.1-47.0)

  4. Evidence based clinical trial designHypothermia for acute ischaemic stroke

  5. Evidence based translational medicine Experimental Studies Clinical trial • Multi Centre Animal Studies • confirm efficacy • robust and monitored conduct of experiments • transparent analysis and reporting • deliberate heterogeneity • Systematic review and meta-analysis • how powerful is the treatment? • what is the quality of evidence? • what is the range of evidence? • is there evidence of a publication bias? • What are the conditions of maximum efficacy?

  6. Data: More are better Cumulative meta-analysis of the efficacy of lytic treatments (eg tPA) in thrombotic animal models of stroke NXY-059 Hypothermia

  7. Clinical trials and in vivo studies

  8. MultiPARTMulticentre Preclinical Animal Research Team

  9. What we’ve found out so far … • Animal studies which do not report simple measures to avoid bias give larger estimates of how good drugs are • Most animal studies do not report simple measures to reduce bias • Publication and selective outcome reporting biases are important and prevalent • You cannot assume rigour, even in Journals of “impact” • You can only find these things out by studying large numbers of studies

  10. What we’re looking into now… • Can we advise scientists on more efficient research design? • Can we use this approach better to understand animal models of mental illness? • Can we automate some of the techniques required? • Can we help publishers improve quality? • 3000 publications are added to PubMed each day– can we build tools to provide up-to-date research summaries? • Can we use this approach to design better clinical trials?

  11. Deaths from Stroke, ScotlandAge 70 to 79

  12. Abraham Maslow “To a man with a hammer, every problem looks like a nail” George Santayana “Those who cannot remember the past are condemned to repeat it” • Karl Marx • “Hegel said somewhere that history tends to repeat itself. He forgot to add that the first time is tragedy, the second is farce”

  13. Acknowledgements

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