Hot on the heels of my office next door neighbours SoMe course we’re off with a ‘Top Tips’ post. (Anyone who hates the cheesy format can comment below or tweet us @ADC_BMJ.)
Please imagine a racing, 5-years-before-you’re-reading-this-pop-tune as your background music.
1. Know your question
Know what you’re asking. And know why you’re asking it. And know what you think the answer is, before you start looking.
2. Use sensible searches to crack high-quality resources
Don’t waste your life doing a systematic review that might well already have been done, appraised and packaged for you.
3. Appraise things using checklists to help you.
They help. They don’t command and control. And they are a Checklist, they are not The Inviolable Truth.
4. Decide what you think the answer actually is.
Do this on the basis of your appraisal. Now check back to what you thought the answer was (#1).
5a. If you’ve decided to do something – do it.
5b. If you’ve decided not to do something – think.
Are you actively not doing something? Or just not doing because you don’t believe the answer from #4? If so – how great would the evidence have had to be to press you from what you thought the answer was? Just how ‘anchored’ are you to your initial beliefs?
I spend some of my time working in a hospice for children and young people, and much of that time I know I am looking after patients who, themselves or their parents, know more about their condition than I do. Dealing with this – when I’m asked to review someone who has something I know I should have actually learned about at Part II and didn’t – was initially quite unnerving. more…
There’s something that is frequently wittered about but the odds are you’ve never really been bothered enough to care if there’s a difference between ‘probability’ and ‘odds’ (like relative risk and odds ratios).
There are great reasons for this. Coffee, beer, ‘Take Me Out’ or a crash call to labour ward are four, for example. But given you’re here now … let’s address it.
The main things we look for when examining a new diagnostic test are “Is it as good as, or better than our usual one”, “Is it quicker?”, “Is it cheaper?” and “It is easier for patients/less dangerous?”
While the latter three questions can be assessed by asking the folk who do the test, asking the managers who pay for the test, and undertaking an adverse effects systematic review, it’s the first of these that we tend to call “diagnostic test accuracy”, and as clinicians we want to look for “phase III” studies.
The premise of such studies is that we can evaluate how accurate a test is by comparing its results with that of a ‘reference standard’ – a thing by which we will judge if the patient really does, or really doesn’t, have the diagnosis in question* – in a group of patients in whom we want to know the answer.
The essential elements of a differential diagnosis study are, like most of critical appraisal, really simple and straightforward.
You need to start with a bunch of children/young people who turn up with the symptom, or symptom-complex, you’re interested in. Ideally, you need these folk to not already be known to have something, to attend a similar type of facility (e.g. office for general practitioners, or ED for ED types), and to be a consecutive group or random sample. more…
Grandma says it. Great-grandpa says it. Even the wife’s starting to say it.
Its it true? Are things just not as good as they used to be?
Well, while we will leave the greater political discussions to others (except to note the falling child mortality rates in most countries) we can focus on how drugs seem to be less effective over time. And not just antibiotics.
The constant refrain from many a consulting room is not “How can you make her better?” but “Can you name the problem so I can own and understand it?”. When addressing this need we will each develop our own approaches; some of us will explore differentials, others state the top of our list, others delve into the concerns sitting behind the inquiry. When addressing the content – what’s actually wrong – we’ll probably want to come up with a diagnosis.
This January sees the UK submitting its fifth periodic report to the UN Committee on the Rights of the Child outlining the progress over the last 5 years the UK has made in meeting its obligations to the United Nations Convention on the Rights of the Child (UNCRC). The UNCRC is an excellent piece of child specific global legislation that almost all nations worldwide agree on and that our government is accountable to. It covers over 40 rights looking at child survival, development, wellbeing and participation and several articles specifically address child neglect and abuse: see here for more detail
Previous recommendations from the last UK report in 2008 included prohibiting as a matter of priority all corporal punishment in the family and intensifying efforts to collect data on the extent of sexual exploitation. We haven’t made much headway in the former but have made good progress in the latter as evidenced by ‘If only someone had listened’ from the Office of the Children’s Commissioner, whose very existence in England is actually directly attributable to the UNCRC.
This report also comes just a year before 2015: the line in the sand for the Millennium Development Goals established in 2000 and discussion has been fervent – what comes beyond 2015? There are calls for adequate attention to child protection on a global scale to be a key component post 2015 – Surely a most marvellous way to put some of the key articles of the UNCRC front and centre and make safeguarding children (and their rights) a global priority?