Does having the a worried mum or fretful dad in the room with you make a lumbar puncture less likely to succeed? It’s an interesting question, and one that has been posed following an evening on call in Yorkshire. What’s the opinions of folk out there - and any evidence that you can quote to substantiate them?

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Have you (yet) had a parent ask for a referral for tongue tie division to assist with a poorly feeding baby? What is the right answer to this question; more…

Have you ever been involved with a debate with a partner or colleague, travelling from one place to another, and when the course they took has got you to the destination safely, they turn to you and say “So, [add endearment here], you see my way was right.”? If you have, I doubt that you took the opportunity to explain that they may be suffering from a methodological reasoning problem, of which the conterfactual argument and the possibility of differential verification bias may be important to consider. more…

The separation of ‘risk’ factors and ‘prognostic’ factors at first seems the sort of obsessive fine detail that gives epidemiologists and statisticians a bad name. Sadly, the difference is actually worth understanding for any clinician that’s going to try to cut through an observational study and understand what it might be truthfully telling us. (This isn’t the true of the difference between a Peto odds ratio meta-analysis and a DerSimion & Laird random effects meta-analysis. That is a pointlessly academic difference.) Fortunately, the difference between risk and prognostic factors is straight forward. ‘Risk’ factors are those which as associated with causing a condition (like smoking for lung cancer, being premature for chronic lung disease, or soft light and wine for falling in love). more…

Sometimes we are in situations where we think that something causes problems, and we can’t do a trial randomising one group to get something which we think causes problems! How do we then go about finding out - how to we avoid the problems of ‘confounding’ - and what is that anyway? For example, think about necrotising enterocolitis. Which babies develop NEC? more…

If you were offered a choice of medication to treat an ailment you were suffering from, and you’d asked about how effective they were (and there’s a huge chunk of the population that wouldn’t, and would be happy to just do as they are told), then what information would you like? more…

That’s it really - it’s a very simple question. Does the time, effort and printing resources we use in creating asthma action plans have a measurable benefit in terms of stopping the kids getting as poorly? Or is it a job-creation scheme for these financially strapped times?

Does oral aciclovir improve clinical outcome in immunocompetent children with primary herpes simplex gingivostomatitis?

A 3 year old previously well boy presents with a fever of 38.6ºc and several ulcers and erosions extending from his lips, along the tongue and cheek, to the back of the throat. The lesions have all appeared within the last 2 days. He has been crying inconsolably over the past 24 hours and is refusing food and drink. Is the use of oral aciclovir is indicated for primary herpes gingivostomatitis in children?

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A 6 year old girl with Acute Lymphoblastic Leukaemia presents with another episode of febrile neutropenia with positive blood culture from her Hickman line. On a ward round, her parents discuss that they would like her to have a Portacath device inserted so that she can go swimming and is more comfortable around her friends. They are worried that she will be more susceptible to infection as the device is just below the skin and would like to avoid further hospital admissions. They ask if the portacath will increase her risk of infection during her remainder of her treatment? more…

When I was doing neonates, it was considered good practice to get little babies spliced away from their Mother, given oxygen to breathe and wrapped up warm, all pretty damn quickly. I keep hearing rumours from my neonatally biased friends that perhaps there are other, better ways of doing things.

So - how long do you advise waiting until clamping the umbilical cord after delivery? Two, three minutes (where the baby can chill & develop polycythaemia?) or as little time as it takes you to get hold of a clamp (so the child can be deprived of the last few teaspoons of good fetal blood?).

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