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ADCE3 – Nothing seems right

28 Jun, 16 | by Bob Phillips

download (1) There are some times when it seems that no decision can be the right decision but doing nothing is as much as a decision as doing something.

Admittedly, it’s rare you’re faced with shooting a killer in cold blood to prevent him murdering a not-so-innocent man.

But sometimes the triadic nature of paediatric & adolescent medicine causes us trouble. more…

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.

Why?

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?

more…

More than numbers: Why use focus groups?

14 Jun, 16 | by Guest Post

Dr Jess Morgan, working in the University of York, has taken time out from writing up a massive mixed-methods study to splurge on why you might like to use focus groups in your research study. You see, they aren’t just a way of getting a tonne of interviews done without having to do all the driving between coffee shops.

There are loads of different reasons that you might choose to use focus group discussions instead of individual interviews when carrying out qualitative health research. I’m going to outline my top six (there are more but six seems just about enough)….

more…

StatsMiniBlog: Path analysis

10 Jun, 16 | by Bob Phillips

calculator-97842_640It’s been a while since a little burst of statistical fun hit the blogosphere but summer is sort of here, and you may be faced with a choice of tracks in a forest and unsure which one to take …

Path analysis will not aid you.

Path analysis (aka ‘structural equation modelling’ … sort of …) is a type of regression analysis, where you try to predict one thing that you don’t know (for example, final hight of a child) using stuff you do know (like the height of the parents, current age, height & pubertal status).  more…

ADCE2 – When two tracks diverge in a wood

7 Jun, 16 | by Bob Phillips

Acker+Bilk+Cocktails+For+Two+499808You’re sure to remember the ethical dilemma in ADCE1 – the overheard conversation of information that may have done more harm than good – and you’re likely to have spend hours awake, wondering about the next dilemma to come your way.

Will it be, as posed by Emma Neumann in the “Tea & Jeopardy” podcast

“If you were to be approached by someone holding two cocktails & wearing nothing but a winning smile, who would it be?”

No.

more…

Onwards and upwards? The first few months as a consultant

3 Jun, 16 | by Ian Wacogne

Picture1You’ve made it. You have new shoes. You cut your hair and filed your nails.

What else do you need to do to get through your first few months as a new Consultant?

Well, nobody can tell you precisely how to survive your first few months as a consultant.  However, Ian, Vin and Helen do have a (quite a few) thoughts that you may find helpful.

more…

More than numbers: The biology of complex interventions

31 May, 16 | by Bob Phillips

LighthouseYes” said the slightly cross voice, clearly meaning ‘no’, not ‘yes’ …

Yes, I can see how that might be nice to know, but what we actually care about is ‘does handing out the information sheets actually get the parents to do the right thing?’ 

[A mildly fictionalised account of a research group encounter]

Sometimes it’s tricky to see the point in qualitative research, especially if you’ve grown up in an environment of number, bias, randomisation, confounding and precision. Sometimes the concept of research that works by asking people what they were feeling, enquiring about how they were thinking, exploring how and why they act in particular ways, can be very … well … sociological claptrap.

If instead of thinking that way, but perhaps considering how we might go about developing a new drug, you’ll start with wanting an understanding of the pathology, the mechanisms of abnormality and the dynamics of the medication.

So with some qualitative research; it can unpick the social mechanisms and meanderings that influence why stuff happens – and why it doesn’t – which are essential to underpin any intervention of a ‘complex’ nature

  • Bob Phillips

Getting through the interview. FAQ about Q.

27 May, 16 | by Ian Wacogne

Picture1

So there’s maybe a few things that you’ve always wanted to ask about Consultant interview questions but never quite found someone to speak to … or perhaps found someone who you could ask but feel too daft to do so … well.

Once again we’ve got Ian, Vin & Helen to rescue you.

more…

(Guest post) No more broken backs

24 May, 16 | by Guest Post

131001donkeystraw1In this guest post, Gabriella Morley reflects on her experience as a just-qualified doctor in paediatrics in Birmingham, UK, and what the experience of the “Learning From Excellence” model feels like to those under the greatest strain at the moment – junior doctors in England.

It could probably be said that this was one of the most turbulent and uncertain years for doctors in the NHS. Yet the contractual dispute was the proverbial last straw causing the final break in our backs. For a long time now, morale in the NHS has been fading.

I didn’t really get this though before I started life as an FY1 back in August ’15. How could people be dissatisfied, frustrated or, frankly, just down right fed up when they are doing, what I perceive, is a very meaningful job?Of course that’s naive, but until you’re in its hard to fully appreciate just how stretched the system is. Now I know, there is a constant in our hospitals which is a backdrop to our day: tension. It’s almost palpable. We feel under pressure constantly quite simply because there is demand greater than our supply. The beds are full, the A and E swamped and ‘crisis’ is becoming a norm. We worry about what our next shift might have in store for us as the rota gaps get more prevalent and the workload intensifies. We are scared that this struggling system may mean we slip causing damage to the very people we so badly want to help. It’s thus not surprising that morale, “the level of psychological well-being based on such factors as a sense of purpose and confidence in the future”, is looking a bit peaky.

more…

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