22 Sep, 14 | by Bob Phillips
“Spot on!” is a rather anachronistic and very Anglophile phrase, redolent of croquet lawns, tweeds and well designed woven straw hats. It’s no wonder we tend to use – if we are being technical – the word “accurate” instead.
But should we be using the word “precise” to make ourselves sound all academic? And what’s the difference?
Accuracy – the closeness a thing to it’s target
Precision – how close repeated attempts are to each other
Now those two things do not have to be connected – you may be accurate and imprecise, or inaccurate but very precise, or .. Oh forget it.
Let me just show you a picture …
18 Sep, 14 | by Bob Phillips
Lots of debates could be had off this title. When is an ‘audit’ and audit and when is it a cloaked piece of poor quality retrospective research? Why is ‘research’ considered better just because it’s ‘special’? What makes research study data forms nearly impossible to understand without spending 3 days in a steam hut wearing just a loincloth made of old patient information leaflets and drinking far too much Red Tea?
What I think it’s worth taking up, for a just a bit though, is ” What is routinely collected hospital data and it’s relationship with the real world? ”
15 Sep, 14 | by Bob Phillips
I am a glutton for podcasts, occasionally medical, but often way off this mark (sociology, philosophy & rugby league would fall into this category), yet they frequently play into each other. Some of you will recall this, as I note that when I can’t concentrate on a podcast, I know I’m becoming overloaded/over worried and need to step away from stuff to regain my good mental health. Podcasts are my pants drawer.
However, my own state of mind is not the key in this entry, but an ancient philosophical problem.
The Sorites Paradox.
11 Sep, 14 | by Bob Phillips
How can we determine the safety if anything we do in paediatric prescribing? For chronic conditions, we’re generally pretty sure that if we let it wind on, it will harm the child. If we treat it, we’ll be managing the disease but causing adversity. The balance is making this tip where the good stuff overwhelms the poor stuff.
I think the commonest, extreme, example is chemotherapy. These agents are intended to treat a cancer to save a life. To do this, they may cause sufficient immunosupression to produce a fatal infection, or mucosal erosions to give a fatal intestinal perforation, or a thrombotic event that produces a cerebral infarct and death. The carefully measured doses of these drugs are placed to make the tipping point in favour of benefit over harm; and we have improved survival in childhood cancer by this treatment approach.
7 Sep, 14 | by Bob Phillips
If you’ve only recently bumped into this blog, you may not be aware of the near-obsessive compulsion for us to ask “Is there a systematic review of that?” at any opportunity. Why is this the case? Well, partly it’s the job. Mostly it’s because systematic reviews give us the best answers to our questions … and in this Basics blog we’ll cover
- What is a systematic review?
- What is meta-analysis?
- What can a systematic review do for us?
3 Sep, 14 | by Bob Phillips
I guess part of me wants to start this blog with “Never knowingly topical”, but in the UK an as yet unclear explosion of media interest has been generated around decision making and a child with a brain tumour.
Those who want to can find out more via reputable news sites – as a staunch middle-class Northerner, I’ll just link to the BBC from the start of the very long story.
Where much of this very difficult story seems to be around consent, and best interests, I’d like to take a more routine approach to the issue. How do we, in everyday care, make sure that our interactions with children, young people and their families share the decisions as much as possible?
31 Aug, 14 | by Bob Phillips
We’ve mentioned before about the COMET initiative, that was born from lots of work in rheumatology, and seeks to standardise a core set of outcomes collected in clinical trials so that the trial
- Measures things of importance to patients, clinicians and researchers and
- Provides a degree of homogeneity that makes systematic reviews more powerful
Well, those clever rheumatologists have done it again, conceptualising the whole of it into two major areas, and breaking them up into manageable parts.
20 Aug, 14 | by Bob Phillips
Pretty much sure that you’ve all hit something complicated and, after trying to explain it, have grabbed pencil, paper and said something like “Look, you see, it’s …”
And your picture may be completely unlike the thing you’re describing.
Well, hot on the tails of our Archi blog about the challenges with ‘standard care’ as a comparator comes a really nice way of thinking about complex variations in studies included in systematic reviews. Admittedly, the title is a tad off putting “Evidence-based mapping of design heterogeneity prior to meta-analysis: a systematic review and evidence synthesis” but the idea – along with it’s beautiful execution in examples – is that we can use a rather neat tabular design to outline where studies vary and how this might explain differences and need to be understood in our translation / incorporation of the outputs into clinical practice.
There’s a wealth of stuff written about visual display, and of course, an entire industry dedicated to it, but we docs do tend to ignore all that sort of stuff, don’t we?
What’s your ‘best’ example of great graphical representation making something terribly complicated enlightened? Comment, FB us, or tweet it to @ADC_BMJ #NowIsee
17 Aug, 14 | by Bob Phillips
Holidays are lovely things, and I would greatly advise everyone to take one. A proper one, where you switch off your emails (?perhaps even deleting those that arrive?), ignore your work texts and generally hide in a work-free hole for a while. You might think about doing this every weekend you’re not working, or instituting your own digital sabbath, perhaps, to keep topped up with the goodness that isn’t work.
It’s always good to look at things with fresh eyes, and I would encourage you to have a think about research that doesn’t centre around assumptions of normality, stochastic thinking and positivist ideologies. Instead of ‘what happens when ..’ ask the ‘how & why do people ..’ questions. more…
1 Aug, 14 | by Bob Phillips
It may not have escaped your notice as you travel between different areas of the hospitals in which you work that there appear to be some things that have more clinical trial activity going on than others. There have been many things written on why this might be, including a very persuasive paper* that argues for the reduction in health waste by the better integration of clinical care and clinical trials, and a claim that trials are an ethical imperative.
Yet not an awful lot of folk are on-trial. Why?