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Strawberry stories

21 Jun, 16 | by Bob Phillips

strawberryMy mum insists that we, at home, always cut off the green bit & splice the strawberry in case it had a slug in it.

For Ian Wacogne it’s sitting with his back against a radiator.


Well, in my case it’s so that you can’t eat a slug … that’s managed to get into the strawberry without having left a hole / magic taped it together afterward .. garbage, yup?

I asked my mum about it. She said that my grandma had told her she had eaten a slug in a strawberry when she was little, but that no, she didn’t remember eating the slug, and actually, on recollection, it was that she had nearly eaten a slug in a strawberry …

Such ‘strawberry stories’ are prevalent and problematic. They exist in clinical medicine, research and publishing. Some we’ve heard recently:

“You can’t publish fetal or animal papers in ADC F&N” … You can

“You need NHS Ethics to involve patients in developing research studies & protocols” … You don’t

“Multi-disciplinary research is never worth the effort” … Nope

Identifying these strawberry stories, and overcoming them should probably be one of the tasks we take on every day. I wish I could point you at high quality evidence of how to do it, but sadly, I can’t.

  • Archi

Quality Improvement: Why it’s not turfing the RCT to the long grass

17 Jun, 16 | by Bob Phillips

We’ve started to publish a fair few quality improvement reports in the Archives recently, aiming for 1200 words, 5 references and a readable SQUIRE-compliant paper that gets across the key messages about how a #QI project was undertaken.

These aren’t trials, don’t have control arms, and may suffer from significant publication bias. (It’s not surprising to anyone that in my role as an Associate Editor, I’ve not seen a Report that shows how the QI intervention was completely bloody useless.)

So what on earth are we – EBM centric academic ivory towerists – doing promoting these things?


Subgroups and multiple analysis. Truth or herrings?

14 Apr, 16 | by Bob Phillips

river_herring_2We recently published, in the F&N edition, a paper reporting an RCT looking at inhaled steroid in wee premature babies to see if the treatment reduced the incidence of death and chronic lung disease.

Did we do a good job?

The trial was prospectively registered, before enrolling patients, randomised and stated it was more…

Dethrone the “Landmark Trial”

6 Apr, 16 | by Bob Phillips

Geo_Position-512There is a long honoured tradition in a number of specialities, and sub-specialities, of knowing The Landmark Trials. The studies that demonstrated that something works or that some method is better than another.

But Landmark Trials are bunkum.


Overdiagnosis in paediatrics

18 Mar, 16 | by Bob Phillips

WHY is the rate of admission for bronchiolitis skyrocketing?

HOW CAN we combat this clearly terrible condition?

Perhaps we can stop diagnosing it as worth of hospitalisation? more…

Basics: Blame it on me

11 Mar, 16 | by Bob Phillips

In my clinical role, it’s fairly easy to take the blame for most bad things that happen to my patients. I give them cytotoxic chemotherapy (for good reason, honest) and it’s a group of substances that we label with TERATOGENIC! HARMFUL! QUITE BAD FOR YOU! tags a lot of the time.

But how do we know, in most circumstances, if the  drug/potion/puffer etc is the cause of something averse?  more…

How often can you cry “Wolf”?

2 Mar, 16 | by Bob Phillips

The fable of the bored shepherd boy, alone on a hillside (except for the sheep – sheep don’t count as company*) waiting for something to happen, is one that I hope most of us know and can recount if needed at any dinner table.

In my folk-recollections of the tale, it’s three times that the lad calls “Wolf!”. Twice he gets the thrill of a village-load of yokels pounding out to his hillside vantage point, and it’s the third – truthful – one that everyone ignores and the sheep get gobbled up.

How many times can we call “Wolf!” on a ward and get away with it? Or – how good does a PEWS need to be before we’ll think it’s useful?


How do health care teams talk about very-low-success interventions?

2 Feb, 16 | by Bob Phillips

The_ScreamThe situation is clear. The child has an illness which is very likely to end their life – and soon – in days, not months or years. They may be hooked to a ventilator, drizzled with inotropes, or osmosed. The health care team is talking – once again – about the outcomes and what we can, should or will do.

Do you recognise this?

Do you recall how people spoke – not the ~mab, the pressor or the particular hospice name – but what the emotional and moral content of the discussions were? Can you recall if that varied between professional groups & experience of those folk? And if there were clashes between how people felt the actions should flow, against how they were made to act?

This is the question that has been investigated by a new systematic review in the ADC, drawing together original papers who have enquired about ‘moral distress’ in NICU / PICU


Getting the message across

29 Jan, 16 | by Bob Phillips

NewEBMPyramidThere’s a rather neat editorial in BMC Medicine that discusses how academics might better write their papers to inform and influence policy makers. I was taken with how much the tone of this, and the excellent mini-series of blogs on presentation skills by @ffolliett, were similar and applied to all sorts of layers of ‘policy’ making.

Take the ‘policy’ being made on your unit – guideline implementation, the ‘how we do stuff’ of everyday practice, the business case for a new ‘Where’s Wally?’ book pre-cannulation – and think how you might want to be given the evidence that underpins the actions. more…

Steroids are bad for you. Lifesavingly so.

19 Jan, 16 | by Bob Phillips

Dexamethasone_structureThere are two newish articles on steroids in the Archives – one is a systematic review of adverse drug reactions (ADRs) from short-course use, and one the initial creation of a quality of life tool intended to be used to look at how steroids, particularly dexamathasone, affect the life of those children and young people who get it.

It’s reminded me that steroids are really quite bad for you. But lifesaving too.

Quick poll then: which of these are common (>5%) side effects of short course steroids?


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