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What’s stopping you?

24 Nov, 15 | by Bob Phillips

Bovril_250gActually turning the fascinating discussions you all have (I’m sure) over breakfast, beer or bovril about the latest systematic reviews, touching on all elements of critical appraisal from their complex search to their use of mixed logistic regression meta-analysis into action is, sometimes, difficult. We all stop on our course from asking questions, through acquiring information, and appraising that evidence, before we hit the application of our knowledge in practice. But why and does it vary?


Guest Post: “Not the brightest tool in the box…”

20 Nov, 15 | by Guest Post

622780860_8bb2466176_oAnother guest blog from @gourmetpenguin on the topic of clinical academia brings up an EXCELLENT point that’s often assumed, incorrectly. That is that to be a clinical academic, you need to be really clever. Well …
I spent a weekend at the Clinical Academic Trainees conference in Sheffield in 2015. This is still quite a bizarre thing for me to say, because I never wanted to be a clinical academic. The truth is that it just didn’t occur to me that it was “my” kind of thing. Academia is for clever, brainy people who understand things like thermodynamics and calculus – that’s not me.


Interventions without evidence should not be undertaken. Discuss.

17 Nov, 15 | by Bob Phillips

1024px-Debate_Logo.svgIt’s been a ‘debate topic’ from a number of conferences, medical student societies and online fora.

Should an intervention without evidence ever be undertaken?

There’s a couple of key elements here: one – the idea that there can be an intervention ‘with no evidence’, and two – that an absence of evidence should be interpreted an evidence of absence of effect. Both are straw men.


Re-building pyramids

13 Nov, 15 | by Bob Phillips

TradEBMPyramidThe idea of the pyramid of evidence – where a systematic review, or even better, a meta-analysis, trumps all below it – is something that’s passed into mythical status in evidence based practice. Actually, mythical is probably a good way of thinking about it. It’s not real, not really real. But it’s not quite truthless either. The levels of evidence, like so many other ways of understanding the world, are useful to give us a skeleton, but the meat on the skeleton is what makes it more interesting, fun & cuddly.

Images are powerful though, so when the latest issue of the Evidence Based Health Care Newsletter* came out and showed a dramatic re-imagining of the pyramid – I was hooked


Messed up references

10 Nov, 15 | by Bob Phillips

gold-522369_640Those who are writing a thesis, have just upgraded from one bibliographic manager to another, or have spend a week flying around your (ex) region collecting printed forms to tell a prospective employer you are not a danger to their staff, patients or cutlery may read the title one way.

Those who have been pondering the value of diagnostic test accuracy studies with imperfect “gold standards” may have another.

Take the situation of serious infection in children. We know someone’s got a serious infection because they a) look poorly and b) have a blood, urine or CSF culture that grows a Nasty Bug That Fits The Picture.

We also know that not all bugs that cause problems grown in culture bottles.

So how do we evaluate a new technology, such as PCR-based Bug Detectors; with what do we compare them?


Triple targets

6 Nov, 15 | by Bob Phillips

EBP triadThere’s a triple target that I often splurge about evidence based medicine being the ‘combination of patient preference, clinical expertise and best-available research’ which in context addresses an EBM-is-copying-the-trial critique. The #RealEBM hashtag (go on … give it a go ..) is addressing this quite eloquently and has been graven in stone by the superb @RichardLehman1 in Ten Commandments*

There’s another triple target too, that I bumped into quite recently while doing more work on transition from child into adult health services. This is the aim for transition services to

  • improve patient experience
  • increase community health
  • have an appropriate and affordable cost

Why on earth have I not considered before that these three aims are core to EVERY health care system that we undertake?


Nice and easy doesn’t do it.

3 Nov, 15 | by Bob Phillips


With very little need to comment – this model of getting research into practice by dr prof Trish Greenhalsh – can be used to slap down anyone who turns to you and claims all you need to get X, Y or Z working is just

You’re welcome.


Guest Post: Being a Clinical Academic

30 Oct, 15 | by Guest Post

LabPhillipsFresh from all sorts of Deep Thinking and engaging with a broad range of research, it’s time to turn back to thinking about Turning the Tide and increasing the number of paediatrician types actively doing research as a large chunk of their jobs – clinical academics. Where training systems are in place, and encouragement is available, there’s something a bit odd about stepping off the usual escalators and moving to do something different.

A regular contributor to the @ADC_BMJ social media scene, @gourmetpenguin, provides her thoughts below on what it’s like to live that life … and if you’re intrigued and in the UK, there’s a Conference for those who are, who want to be, or who are just curious going on in Sheffield on 7th November


Guest Post: How do you decide that a child has sepsis (or not)?

27 Oct, 15 | by Guest Post

This Guest Post is asking for your help – your thoughts – on the identification of an Unwell Child. Please – read on and link to the survey at the end ….

The introduction of Paediatric Sepsis 6 along with the recently released guidance notes has caused clinicians and organisations to look at the way that sepsis is identified and treated.
It is a problem that presents different challenges to different disciplines within medicine. A primary care or ED clinician must avoid over-diagnosis while at the same time referring a cohort of possible sepsis and presumptively starting treatment when sepsis is most likely. The secondary care paediatrician will reassess the referrals that may include paediatric sepsis and decide when to treat and when to observe or discharge. The paediatric intensivist will be involved for the most significant cases on admission. Those caring for inpatients will have to use a totally different threshold for considering sepsis, especially when the child is already ill or has compromised immunity.

Medicine has so far failed to find a test for paediatric sepsis. Guidelines point towards red flags but all of them ultimately require a clinician to make a decision.


Guest Blog: Introduction to Trans*

23 Oct, 15 | by Guest Post


There has never been a time in which it is more important for healthcare professionals to be knowledgeable about LGBT (and specifically transgender) issues. This is not limited to adult medicine – many transgender individuals are aware of their feelings from a young age.

What follows are a few general definitions (adapted from my post on Geeky Medics, which can be found here) followed by a more paediatric-specific discussion, with some useful references.

Gender, sex and sexuality are three distinct classifications.

Sex is a biological categorisation – male, female or intersex. This is defined by a number of features; including internal and external reproductive organs and sex chromosomes.


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