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Has anyone ever seen an academic title like this where the answer is “Yes”?

16 Dec, 14 | by Bob Phillips

You know the sort – ” Is survival and neurodevelopmental impairment at 2 years of age the gold standard outcome for neonatal trials?” – have you ever seen one written where the answer is “Yes”?

Go on … have a look and quote us some in the comments.

– Archi

Measuring consentability

12 Dec, 14 | by Bob Phillips

judgementSo I’m inventing words here. Could be worse though, could be “stooling” for “having a poo” or “pedagogy” for .. well, whatever you want it to mean when you really mean “be quiet and listen”.

But how can you judge if a child / young person is sufficiently aware of ‘stuff’ to be able to consent to including themselves in a research study? We are asked in the UK by many Ethics committees to provide assessment information for young children (<8yrs), older children (8-13yr) and young people (>13yrs). It’s almost always the parents who seem to do the deciding though. Could more be sat at the feet of the young people themselves?


StatsMiniBlog: Cronbach’s alpha

9 Dec, 14 | by Bob Phillips

StatsMiniBlogWhen you’re next handing out your questionnaire in clinic, or on the wards, or sit out in the library assessing the results of a recent clinical study, will you be asking about the quality of the questionnaire you’re using or reading about?

Of course. I should have realised you will.

Though you might just have a little niggle about what the Cronbach’s alpha actually means …

Well, it’s a measure of internal consistency – that is, an assessment of how much the rating scale in question seems to measure the same thing. It works by comparing the variances of the results of each ‘item’ (test question, often) with the variance of the overall scale, across a population of folk. If the ‘items’ are all measuring the same thing,  then the alpha value is high (generally speaking, >0.7 has been taken as ‘good’ internal consistency).

– Archi

What moved you to move?

5 Dec, 14 | by Bob Phillips

20140320-145928.jpgWhen was the last time you changed your behaviour? (I’m not talking here of speaking differently to your Mum in Urdu, your sister in Londoneese and your patient in Glaswegian …) When did you last decide “I am doing THIS/THAT thing differently from now on.”

Got one?

Right. Why did you do it? Take 30 seconds to think it through.


StatsMiniBlog: Surrogate, proxy or process?

2 Dec, 14 | by Bob Phillips

20140205-091454.jpgWhen we look at treatments for children’s ill health, we tend to be stuck in a pleasant dilemma. We normally want to use treatments to stop kids dying, and to make them better quicker – but it’s uncommon for children to die, and they’ll often get better anyway. So we end up using alternative outcome measures; a proxy, surrogate or process measure. Do you know what the difference is?


About that ‘normal’ capillary refill time…

28 Nov, 14 | by Bob Phillips

B0u4ZYqCIAAKsOBWell, it might be a few minutes since the last #ADC_JC called time of bile and surgeons, but do you recall all the fury around capillary refill times?

There is a lovely storify from @dralangrayson that tells us about how that expanded and exploded. It was, of course, based on a lovely systematic review and if you’re looking for a refresh on some of the key concepts you can brush up on:

– Look out for another summary coming up soon.

Ignore the platelet count in HSP if you’re wondering about kidneys

25 Nov, 14 | by Bob Phillips

030614_1634_Gamblingalc1.jpgEvery now & then you bump into something that makes your heart sing.

For me, I sometimes struggle to come up with good examples of an ‘EBM’ tennet – for instance, the difference between statistical and clinical significance – which has an actual origin. Well, in a paper entitled Platelet Counts in Children With Henoch–Schonlein Purpura—Relationship to Renal Involvement I think I have hit gold.


StatsMiniBlog: Will Rogers Phenomenon

21 Nov, 14 | by Bob Phillips

20140205-091454.jpgThe American humorist, Will Rogers, was reported to have said (of the migration of folk from Oklahoma to California):

When the Okies left Oklahoma and moved to California, they raised the average intelligence level in both states

While this is a deeply unkind comment reinforcing geographical stereotypes, it does a neat job of capturing an epidemological paradox. If you re-define group definitions, you can make both groups averages improve (survival, or IQ) without changing one jot the overall truth. Such a phenomenon must be guarded against when re-defining risk groups, for example on the basis of new diagnostic technologies, and seeing ‘group based’ benefits.

To take it pictorially: more…

Deliberation and determination

17 Nov, 14 | by Bob Phillips

What does it mean to have a choice in your care?

It’s an interesting question, I think. And may not be as neatly answered as the pat response to an exam: “for example, let the child choose which book to look at while you do the venipuncture!.

If you can’t influence the final yes / no – can you be involved in the decision?


Guest Blog: Beyond the stereotypes – getting to the heart of medical management

14 Nov, 14 | by Bob Phillips

david-brentWhen you think of a manager, what image springs to mind? For me, earlier in my career, I may have pictured Montgomery Burns, the quintessential evil capitalist manager of Springfield Power Plant in ‘The Simpsons”, or David Brent , the hilariously incompetent regional manager of Wernham Hogg, in “The Office”.. Perhaps our opinions are influenced by the media, where greedy ‘fat-cat’  NHS managers are often criticized and scapegoated for NHS failings.  Could these negative stereotypes be divisive, alienating clinical and managerial components of the NHS team? And could poor relationships between doctors and managers be counterproductive in the effective running of the NHS?

Until recently, I had very little contact with any NHS managers, and thought that they cared more about money, bureaucracy and politics than patients. This opinion was only informed by what I had heard from other doctors, the media, and the frustrating dealings I’d had with medical staffing departments at numerous inefficient hospital inductions. One memorable interaction resulted in doctors losing our only meeting/seminar/break room, as a result of a top-down decision by a ‘faceless’ manager, grand rounds were re-located to a soft play area where latecomers had to sit on an animal beanbag, or even worse the floor. I have also lived through challenging change in the NHS, driven by political agenda and largely facilitated by managers. I perceived a gradual erosion of doctor’s professional autonomy, with us coming under growing scrutiny through revalidation, targets and inspections, implemented mainly by non-clinical figures who seemed to me to have little insight into the realities of ‘front line’ work.

So when an opportunity arose in my latest training post to meet and work with a manager on an NHS Change Day project at Birmingham Children’s Hospital, I was both curious and keen to discover what managers were really like and share my opinions and insight into patient care. more…

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