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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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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?

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The crumbling of the pyramid of evidence

3 Nov, 14 | by Bob Phillips

The ‘old way’ of thinking about the hierarchy of evidence was classically envisaged as a systematic review at the top, falling through RCT, cohorts and case-control to expert opinion (and below that, in some iterations, case law & legislative decisions).

There’s been a move against this, with the GRADE system as explained recently in our popular Guest blog: The Systematic Review Speaks The Truth- or does it?

Another example has been published in the tricky field of idiopathic scoliosis, where a group have undertaken an overview of systematic reviews. What they demonstrate, using the AMSTAR approach of assessing systematic reviews, is a huge swath of low-quality reviews when assessing non-surgical interventions. The conclusions of these reviews appear to be more likely to be ‘positive’ than the higher quality reviews, much as expected.

While this message is not startlingly new, it does reinforce the need to always, always appraise the evidence you are looking at. You can do it quickly. You can do it extensively. But you need to do it.

– Archi

Always question your question

30 Oct, 14 | by Bob Phillips

I was recently at a wonderful conference in Toronto, where 1900 folk interested in childhood cancer came together to learn, argue, network, present and be merry – #SIOP2014.

There was a particularly interesting debate between two very clever oncologists about whether or not we should use antifungal prophylaxis in children with AML and post-stem-cell-transplant. (Both are at high risk ~10% of developing fungal disease.) Now there are, as you probably know, two main classes of antifungals – the anti-yeast agents, and those with broader, anti-mould activity. Invasive yeast infections can be deadly; about 25% mortality. But invasive mould infections are said to be worse – around 50% mortality.

The debate centred around what class we should be prescribing. One group advised anti-mould, and one anti-yeast. They both had the same evidence to work from. Why the difference?

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