Carl Heneghan

And my point is, and I think this is interesting, is how do we then translate this evidence into clinical practice and into guidelines, as opposed to now have to wait two or three years to implement this sort of intervention?

Well, I think, look, it has a number of strengths in the outcomes.

I think first is there are not just one or two trials.

There are, like I said, 61 trials, including over 12,000 participants.

What it did is it reduced 28-day mortality, not by much, but enough to make it of importance.

Among 1,000 patients, about 24 more will be alive at 28 days.

But particularly, it reduced the length of intensive care unit stay by a day and large reductions in length of hospital stay over a day of the mean difference.

And one of the most crucial things about this is that what you worry about steroids is, do they actually increase your risk of what they call super infection?

And there was no increase in the risk of such infections because what people worry about steroids is they have an effect on your immune system, so you're more likely to get an infection.

The answer is no, and that was backed up by 25 studies and moderate certainty evidence.

On the steroids?

Yeah, no, I totally agree.

And I think this is an important point because our structures at the moment are sort of set up to move very slow.

But what we see is a move from the systematic review community into these living reviews to make them more up-to-date and more relevant.

And I think we need a policy sort of living approach, particularly for these important questions that go, here's a rapid recommendation into a policy that changes practice.

Yeah, do.

Interesting.

I thought there were two really neat things about this.

One is I want to just raise the importance of clinicians and using your experience and expertise and submitting responses, because there's a response that says, although this is high risk patients, that those with liver disease.

you should treat this issue with caution because although patients with chronic liver disease are at risk of peptic and stress ulcers, portal hypersension is responsible for about 70% of the GI bleeds, and this will not be affected by PPI.