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A picture paints a thousand words

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

 

 

 

What stops us getting more people into clinical trials?

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?

more…

Words, listening, and the art of applying the general to the specific

24 Jul, 14 | by Bob Phillips

A little bit of a swirl around a decade-old paper by @iona_heath on the trouble with turning a patient’s experience into something that might require medically fixing that was floated about twitter recently.

The paper, which is densely written and has lots of lovely quotes from proper writers, and speak of many aspects of doctoring, holds to a thesis that the truth of the patient’s condition is their living of it, and as doctors, we mould and warp and misrepresent it to fit into a diagnosis, reject a diagnosis, or hold as an uncertainty. more…

StatsMiniBlog: Kappa

16 Jul, 14 | by Bob Phillips

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After a short pause while brain cells were diverted elsewhere, we’re returning with the critically acclaimed (well, slightly positively tweeted) StatsMiniBlog series.

(As an aside – do let me know via comments, Facebook or Twitter if there’s an issue you’d like to see covered)

Kappa (κ) is a measure of agreement, usually between two observers of a dichotomous outcome although there are variants for multiple observers.  It gives you a measure of what agreement you see that is ‘beyond chance’

more…

“Compared to standard care”

9 Jul, 14 | by Bob Phillips

There’s a decent argument in the analysis of quantitative studies of therapies, particularly using RCT designs, that says that we should be looking at the totality of unbiased evidence (systematic reviews) rather than looking at individual, cherry-picked, studies. The best estimate from this come from a pooling of all the results: meta-analysis.

There’s a challenge to this, though, when the comparisons are not quite the same. In the case of trials of drug A vs. B, C, D and E it can be quite easy to spot (and then perhaps undertake a network meta-analysis to address the issue). When the trials are A vs. standard care it’s a greater challenge to see if & how “standard care” varies.  more…

The despair of the box-ticking paediatrican

1 Jul, 14 | by Bob Phillips

So, as the annual assessment of learning by paediatric trainees reached fever pitch in many ares of the UK, a question rang out across Twitter:

In (trainees approaching ARCP), does (shoehorning logbook to curriculum) compared to (reflecting on clinical experiences) improve outcomes?

And while this, I feel, is more of an emotional outpouring to garner peer support, love and recognition of the need for coffee rather than an evidence request, there are some data supporting the use of work based assessments and e-portfolios

more…

StatsMiniBlog: Rethinking meta-analysis

15 Jun, 14 | by Bob Phillips

StatsMiniBlogThe concept of meta-analysis was addressed previously, essentially pulling together data from a range of different studies and assuming that they are only (fundamentally) different by chance, or differ by real things too as well as chance, and you’re seeking an average effect across the average of these differences. The maths under this takes each study as an item, and comes up with a weighted average of the effect sizes.

There’s another way of looking at this: more…

When a test isn’t a test

8 Jun, 14 | by Bob Phillips

There are many reasons why we request tests, in medicine. One imaginary patient’s journey picks up a number of them.

Take a patient who presents with a painless lump on their arm, who’s tired and a bit pale & washed out. You might send a series of blood tests, including a full blood count to diagnose anaemia. You may also request an ultrasound of the lump, which may show an ugly mass with features consistent with sarcoma. Your friendly local plastic sarcoma surgeon might do a biopsy for you after an MRI, and the histopathologists confirm it’s a rhabdomyosarcoma.

All these tests are aimed at making a diagnosis: to clarify if the patient in front of us has, or does not have, the condition.

The oncologist who then takes up the patient’s care will move to undertake a series of further investigations; more…

Different but similar. Life-limiting long-term conditions in children.

25 May, 14 | by Bob Phillips

One of the great professional joys of a part-time life in or about paediatric palliative care is being made constantly aware of how much there is in the world that I know next to nothing about. (One of the great personal joys is being able to do something that improves a short life, within a multi-professional team.)

One thing that has always been a sneaking under-feeling, perhaps based in a desperate hope rather than any evidence, is that there are a core of things that children with life-limiting conditions struggle with, and that if I can keep up my skills in constipation management, pain relief, emergency seizure control and sleep hygiene I’ll be able to do some good.

Well, this month in the Archives there’s a reassuring paper that sort of agrees with my unstructured assessment. more…

Boundary spanning in collaborative networks. Asleep yet?

21 May, 14 | by Bob Phillips

Sometimes you need a massive push to take you beyond a title into reading a paper.

(Well, when I say sometimes, I mean ‘most times’. Often, the push can be the patient that has driven you to start looking. Sometimes the push is the grand round or journal club you need to present. Rarely, it’s because you just want to expand you mind a little more than “high CO2, increase frequency” … )

Bridges, brokers and boundary spanners in collaborative networks: a systematic review” actually contains a mass of really deeply interesting ideas. more…

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