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archimedes

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

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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…

StatsMiniBlog: ROC plots

19 May, 14 | by Bob Phillips

A (while ago) we published an explanatory page about ROC plots in the Education and Practice journal. There are a few great reasons why we should replicate it here:

1. So people can read it more easily

2. Because it fits into the stuttering series on diagnostics

3. It saves me having to write the same thing in different words.

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Underpowered and over here.

14 May, 14 | by Bob Phillips

From @aLittleMedic

We’re great fans in the Archimedes blog of trying to get people to think about the meanings and impacts of research, like asking What would Jack want and not believing p-values. One key idea is that of an ‘important clinical difference‘ (see – avoided significantly …) that is essential in working out if a trial is telling you two treatments really are equivalent, or if the study is just underpowered.

If you’re designing a trial you’ll be wanting to be very very sure that this difference, that you’re gong to base all your study numbers upon is, made upon the best possible grounds. Aren’t you.

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Let me tell you a story … journal clubs as literary criticism

23 Apr, 14 | by Bob Phillips

From the worlds greatest comic

 

 

Have you ever been to a journal club and had the slight suspicion that what you are addressing isn’t quite on-target? (Ever been part of #ADC-JC and realised that most of Twitter appears to be whispering at the back and passing notes to each other?) Ever considered if journal club really is a scientific pursuit?
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A spoonful of Septrin helps the carinii stay down?

16 Apr, 14 | by Bob Phillips

 While the diagnosis of Pneumocystis carinii Pneumonia (yes – I know it’s changed it s name – but really, do you ask for Beanz when you want something tomatoey to go with your sausage, egg, black pudding, fried bread, mushrooms and juice in a morning?) may not be everyone’s weekly occurrence, there are probably a handful of children who are trying very hard not to develop in in your town.

The traditional approach to prophylaxis has been a spoonful of Septrin (TM), which got modifed to three times/week.  Most of the UK leukaemia fraternity now moves with a twice/week, twice/day approach. But in Italy, there are centre which use a once-per-week schedule.

“On the basis of large RCT?” I hear you ask, knowing the great reputation paed onc has for developing research.

“Not .. quite..” comes back the embarrassed answer. “But there is some evidence …?”

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The Cabin of Dr. Ladhani

6 Apr, 14 | by Bob Phillips

Hot on the heels of thinking about thresholds for action and inaction comes a really interesting paper looking at the risk of serious infection in children with blood or CSF cultures taken in the South East of England (in 1m – 15y olds).

Before going on – what proportion of cultures do you think were positive?


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