While Archimedes does, not infrequently, get all concerned about invasive fungal infections, this post is not of the issue of beta-D-glucan testing, or problems of azole interactions. Instead, its a swipe at the problem of how, given a transparent system of asking questions, acquiring information, and appraising the evidence we can come to such differences when we get to applying this. Why do we find it so tricky to break our clinical practice mould?  more…

Well … it never happened in antiquity.  Archimedes got killed by an invading soldier.

But back to Archi in the ADC – should we abandon this column as the articles are not ‘proper’ systematic reviews, or is a good short-cut review nearly as good as a 12-month long ‘full’ review?

This is, as you would no doubt guess, something that there have been a number of publications about! A recent email discussion on the evidence-based-health listserve on the issue was summarised by Jon Brassey of tripdatabase (of which Archi has repeatedly spoken favourably).

The bottom line is that most rapid reviews are more limited, have less transparent methodologies, are uneven in quality and yet come up with qualitatively the same answer as proper big reviews. So until we have even better evidence comparing the short-cut and the ‘full’ systematic reviews and shows us that the short-cuts are dead-ends, Archi’s staying put for a while longer.

I am regularly faced with questions comparing two management approaches, and sometimes struggle to work out if the data which supports them shows that one thing is better, one thing is maybe not better, but not worse, that the two things are the same, or that we can’t really tell what the differences might be. more…

What can you do when a ‘gold standard’ isn’t actually that good at diagnosing a condition? It can be terribly problematic in interpreting sensitivity and specificity – for example comparing polymerase chain reaction diagnosis of microbiological infection with culture results. The ‘false positive’ may actually reflect real, and otherwise missed, diagnosis, and the ‘false negatives’ a failure of the old standard to identify someone who isn’t really unwell. more…

A while ago Archimedes reviewed the benefits of using ‘pre-appraised’ search resources, short-cuts to the best methodological quality evidence to answer clinical questions. The favoured database of many, PubMed [www.pubmed.gov] has now receieved a new addition to the range of resources on offer.

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Hot on the heels of this great Archimedes on whether or not you should routinely do an LP in infants with a urinary tract infection, comes another publication, covered with a fairly critical review in Journal Watch.
What’s fascinating here is both “sides” drawing a conclusion that they can’t draw. more…

Probiotics are everywhere these days. They are supposed to prevent all kinds of diseases, from infectious to immunological to allergic. Some of the claims have strong evidence, some not. A pilot study by Youngster I, et al, in which the role of probiotics before immunisations is studied, is yet another positive discovery, but there are several limitations that force us to be cautions and not overly excited about it. more…

Did you know that asprin following MI doesn’t work for those with Gemini and Libra star signs? No, it’s true*. The ISIS-2 trial, which deomonstrated the mortality benefits for anti-platelet agents after myocardial infarction with a p<0.00001 only showed benefit for people born in ten of the twelve signs of the zodiac. So if you believe statistics, and randomised trials, then you could save 1/6th of the antiplatelet bill by not giving it to this lot.

… and other Bohemian aphorisms …

There is a quite brilliant paper from the under-advertised PLoS One which shows how, in the are of incubation periods for respiratory disease, Truth By Citation is quite strikingly different than the reality of the evidence. The networks of citations demonstrate how repetition, sometime but not always with a citation, leads to a ‘truth’ emerging which does not reflect the real picture of the evidence.

Truth, beauty, and absinthe

This paper joins a similar mass of information which demonstrates how information about prognostic biomarkers are dominated by the few studies which show remarkably strong associations, and rarely reference the systematic reviews that place the studies in context.
And there is are still the classic example of sudden infant death and sleeping position. more…

Obviously, I’m excluding the rather large proportion of my workload where the presence of white cells in the CSF indicate metastatic disease … but in normal children, if you did an LP on a child after a seizure and got a total white cell count of 19, would you be treating for meningitis?

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