Those of a certain age (“Very Old” according to my children) will remember the usual way of getting association football scores on a Saturday afternoon was watching the TV, and the sports section would show them on the screen. For people who were still tensley awaiting the catch up show on the box later that […]
Category: critical appraisal note
Does PPI make things better?
Those of you in the UK may be struggling to work out exactly which PPI is in this title: is it payment protection insurance? (no); is it that old government/company hospital building thing? (no, and that was private finance initiative, PFI); is it ‘patient public involvement’? Yes! The active engagement of people who use the […]
Looking under lamp-posts
There’s a tale told in the North of a man drunkenly scrabbling on the path at night, met by a neighbour also on the way home from the Hound Of The Roofers pub. “What’ye doin’ Arthur?” asks the upright man. “Loookin f’r mi key!” responds Arthur. “Did y’jus drop it?” asks his inquisitive pal. “Nay, […]
Can our children’s trials work better than they do?
We’re all well aware of the problems of doing randomised clinical trials in paediatrics – small numbers, uncertainty about sample size estimates, lack of funding to undertake the studies – but are we as aware of some alternative approaches that have been used [1]? “Sequential design” studies look at comparing a series of treatments against […]
Cases and controls
I’ve noticed that there are a fair few phrases in the world where there actual meaning can be unclear or uncertain, or possibly interpreted differently by folk. Take “maybe later” when used by parent to child – clearly means “no” to the parent and “yes but not now” to the child. Or “brexit”. But the […]
Basics: Blame it on me
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 […]
Get it straight from the start
Over more than a decade Archimedes has presented clinical queries and the appraisal of the evidence that emerges. leading on to a clinical conclusion to the dilemma. What is strikingly common is that many questions can start in a muddle, and a failure to get an ‘evidence based answer’ might be a failure to ask […]
Proof of equipoise
In order to test a new treatment, in a standard randomised controlled trial, we are ethically assumed to have ‘equipoise’: an honest uncertainty at the same chance of a patient being allocated to the new or old treatment. But, I hear you scoff, how can any investigator put themselves through the hell of ethical administration […]
Cracking the mould
While Archimedes does, not infrequently, get all concerned about invasive fungal infections, this post is not of the issue of beta-D-glucan testing, or problems of azole interactions. Instead, its a swipe at the problem of how, given a transparent system of asking questions, acquiring information, and appraising the evidence we can come to such […]
Tarnished gold
What can you do when a ‘gold standard’ isn’t actually that good at diagnosing a condition? It can be terribly problematic in interpreting sensitivity and specificity – for example comparing polymerase chain reaction diagnosis of microbiological infection with culture results. The ‘false positive’ may actually reflect real, and otherwise missed, diagnosis, and the ‘false negatives’ […]