The bumpy road to evidence: why many research findings are lost in translation

Editor's Choice- Pathophysiology and therapy of myocardial ischaemia/reperfusion syndrome

There is a need to find interventions able to reduce the extent of injury in reperfused ST-segment elevation myocardial infarction (STEMI) beyond timely reperfusion. In this review, we summarise the clinical impact of STEMI from epidemiological, clinical and biological perspectives. We also revise the pathophysiology underlying the ischaemia/reperfusion syndrome occurring in reperfused STEMI, including the several players involved in this syndrome, such as cardiomyocytes, microcirculation and circulating cells. Interventions aimed to reduce the resultant infarct size, known as cardioprotective therapies, are extensively discussed, putting the focus on both mechanical interventions (i.e. ischaemic conditioning) and promising pharmacological therapies, such as early intravenous metoprolol, exenatide and other glucose modulators, N-acetylcysteine as well as on some other classic therapies which have failed to be translated to the clinical arena. Novel targets for evolving therapeutic interventions to ameliorate ischaemia/reperfusion injury are also discussed. Finally, we highlight the necessity to improve the study design of future randomised clinical trials in the field, as well as to select patients better who can most likely benefit from cardioprotective interventions.

Personalizing Behavioral Interventions Through Single-Patient (N-of-1) Trials

Behavioral interventions are typically studied with the use of a conventional between-subject randomized controlled trial (RCT) design. In this design, the effect of an intervention on one group of patients is compared with the effect of a control condition on another group of patients, such that a between-subject change is tested. A between-subject design has an underlying assumption that there is a homogenous treatment effect for a behavioral intervention, drug or psychotherapy, and that the way the intervention operates in the study that will tend to operate in the same way in many other patients. We review some of the philosophical and practical problems with the use of this design when a clinician is attempting to decide on a course of behavioral treatment aimed at within-subject change in patients who are likely to have heterogeneous or unique responses to behavioral treatment. We also review the biases inherent in our current clinical practice model, which does not use any empirical data collection or design for testing if a treatment is useful, and also in the conventional between-subject personalized medicine RCT designs. We propose increased use of single-patient (also known as N-of-1) trials that employ within-subject designs, in cases where treatment response is heterogeneous-as is the case for most psychological and behavioral treatments. Limitations of such designs include that they can only be used when the treatment is potentially reversible, the patient can act as their own control, and the outcome can be measured repeatedly. Increased use of within-subject trials may address in many more instances the more clinically relevant question of how a specific patient will respond to a specific treatment, and could introduce a more harmonious scientific approach into the way we treat our patients. We have incorporated a case presentation that illustrates the complexities of applying evidence drawn from these different designs to selecting and evaluating treatments for the behavioral issues commonly faced by clinicians and patients.

[Quality and integrity in the production and publication of scientific results: data trimming, manipulation and (self) plagiarism]

The publication of scientific manuscripts is an essential part in the research process and in the attempt to produce novel knowledge: only what is published exists. It is the aim of research to produce reproducible and sustainable knowledge. Reproducible knowledge is based on precise observation, the use of modern methodologies and an appropriate statistical analysis. As a consequence, it must be the intention of any scientist to report the truth and nothing but the truth. This principle requires precision and honesty. Deviation from such a behavior may lead to scientific misconduct: It encompasses the use of inappropriate methods and/or statistics, double publication of data, sloppy data presentation and processing, up to data massaging, manipulation, data theft or fabrication. Famous examples can be found throughout the history of research but it appears that such behavior has recently become more common possibly due to excessive competition, the crucial role of grants for scientific productivity and funding as well as promotion. Accordingly, in the training of researchers it seems essential to emphasize the importance of precise data acquisition and analysis to ascertain reproducible data. Similarly, it must be assured that data sets are only published once, that authors have contributed technically and/or intellectually in an important manner and that the work of other scientists is cited appropriately. Editors and reviewers should carefully assess the quality of submitted manuscripts. In fact, it is the aim of the peer review process to assure as much as possible that the quality of submitted manuscripts meets current methodological as well as ethical standards.