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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An eight week old baby is admitted with mild bronchiolitis. His parents mention that he has always cried a lot and that he is having a course of cranio-sacral therapy to try and improve things. You wonder whether there is any evidence for this.

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A 7 year old boy is admitted to the General Paediatric ward with a community acquired pneumonia affecting the right lower lobe. It is suggested on the ward round that we arrange chest physiotherapy to try and reduce the length of his hospital stay. We wonder if there is evidence to support the use of physiotherapy in this case.

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A 7 year old child with a history of cough and fever for 1 week, has bronchial breathing over her left lower zone on auscultation. A diagnosis of lobar pneumonia is made, confirmed on plain chest x-ray, and she is treated with appropriate intravenous antibiotics. However, she continues to have a spiking fever and develops signs of a left sided pleural effusion. Repeat chest x-ray shows a ‘white out’ of the left chest with no mediastinal shift. She is referred to the regional thoracic centre for consideration of thoracotomy and drainage of a left sided parapneumonic effusion. Should she be referred to the surgeons and if so, what should they do?

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A 720g neonate in the intensive care unit develops severe hyperkalaemia with cardiac arrhythmia. The Specialist registrar decides to give a Calcium Gluconate bolus and start an Insulin and Dextrose infusion. The new Registrar queries why Salbutamol and Ion Exchange resins were not considered as these therapies are frequently used in management of hyperkalaemia in older children and adults. more…