The days of a meta-analysis being the simple adding up of lots of studies, pretending that they are all just tiny pieces of the One Big Trial that was performed before the world was made are on their way out. Newer ways of using synthesised evidence - like meta-regression and individual patient data analysis - are coming up quickly.

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John diagnosed with autism at 18 months old presents to your developmental clinic at 30 months old. His mother reports developmental regression of previously acquired developmental milestones. He has now lost his previously acquired language skills and only makes incomprehensible babbles. He is otherwise clinically well and does not have any clinical seizures. You wonder whether an electroencephalogram (EEG) should be performed on John to rule out possible underlying subclinical epilepsy that may contribute to his developmental regression.

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A four-year old girl presents to the accident and emergency department with a history of being generally unwell for the preceding week and on examination is found to have cervical lymphadenopathy. In addition to a volley of tests, a Lactate Dehydrogenase (LDH) was requested by a registrar who had read that this was a predictor of malignancy which came back as 1,750. Should this be seen as suggestive of underlying malignancy? more…

Imagine the situation: you’re in a clinic and in comes a 7 year old child with a belly ache. The ache has been there, on and off for 3 years. Investigations have been undertaken for at least 2 years, in two different centres, and have included blood, stool, radiological and invasive procedures. No clear diagnosis has ever emerged. The parents insist that there is a cause — just that you haven’t found it yet. Sound familiar? more…