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How do you add up if there are no numbers: Qualitative Synthesis

10 Apr, 15 | by Bob Phillips

Regular readers of this blog will know of its penchant for systematic review techniques (evidenced in the recent I-squared blog ). The process of qualitative synthesis uses many of those familiar methods – defining a clear question, systematic literature searching, selecting appropriate research and assessing the risk of bias. Following this, however, qualitative syntheses begin to look really quite different – mostly because there are no nice numbers to add up and give ‘the answer’ but also because they are just not written in language we understand (read the qualitative research blog series to help with this)!

So how on earth do we go about reading a qualitative synthesis and deciding whether its any good?

Well, instead of reinventing the wheel, we can just modify our FAST assessment:
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What about mixedupness?

27 Mar, 15 | by Bob Phillips

The subject of heterogeneity (mixed~up~ness) in systematic reviews is tricky. A bit like ‘significance‘ you can think about it as both a clinical and statistical concept, and in the same way, you can get results that aren’t always concordant.

Many old lags will remember a blog post about a statistically significant association between platelets and renal involvement in HSP. There, there was a statistical association that’s unlikely to be due to chance, but is clinically irrelevant.

The same queries need to be asked of heterogeneity within studies.

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When is enough enough?

20 Mar, 15 | by Bob Phillips

I know that’s a tricky question, and may make you think of cream pouring on apple crumble, discussions about chemotherapy, or episodes of Octonauts depending on exactly what frame of mind you’re in and background you have.

Within a research setting, however, how do we decide when something has been researched so much and folk have repeatedly found no/minimal effect, that we should just give it up. It doesn’t work (enough). This is a key decision to be made, and relies on a mixture of elements.

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When did you last ask about the manufacturer?

9 Jan, 15 | by Bob Phillips

It’s been a week of finding out things I didn’t know I didn’t know about. iCarly, for one. Life expectancy in young people with deliberate self harm for another. And fake medicines.

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What would you like (for Christmas / Birthday / Leaving present …)?

26 Dec, 14 | by Bob Phillips

Now, when you’ve got someone who’s older than – say – five, and you’re not Santa … actually, even if you are … and they have a gift-related event coming up, you tend to ask them what they might like for a present (if you’re in the UK).

(If you’ve not had this experience, you might want to think about how it was when you were littler, and what folk did for you.)

Why do we do this?

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Children are not little adults. Sometimes.

19 Dec, 14 | by Bob Phillips

We reported some time ago that a review of Cochrane reviews (yes .. we are well aware of the meta-meta here ) looking at both adult and child responses to treatments showed, on average, that an intervention was equally as likely to be effective, or ineffective, in children as it was in adults.

Like many averages, though, this one hides a wealth of difference. (Take for example, the question “Do antibiotics help children with fever?” – on average, the answer may be ‘No’, but this will hide those with sepsis who it saves, and those with viral / malignancy fevers who it only gives horrible diarrhoea, rashes and vomiting to.) Sometimes children and adults may have the same ‘name’ diagnosis (perhaps ‘heart failure’?) but have such different pathophysiologies that treatments may be differentially effective.

What about functional constipation?

This is a common condition in children and adults, and it would be great if we could get it fixed. Remember that children with chronic constipation have a far worse quality of life than children with acute leukaemia. An industry-sponsored study looked at Prucalopride

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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?

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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.

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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.

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