Some systematic reviews are confusing. Sometimes this is just poor writing style. Sometimes it’s because the techniques are difficult to grasp (meta-analytic item-response analysis, anyone?) And occasionally it’s because the data don’t seem to add up ‘right’. […]
Category: critical appraisal note
“It ain’t what you say but the way that you say it”
Known and sung about from 1939 onwards, and beloved of puppy-trainers and parents of toddlers, it’s clear that how we say something is often more important than what we say. And we now know that this is true for how we write down clinical recommendations and indicate the weight of evidence behind them. (When I […]
It’s how ineffective?
In the last post I discussed the ‘p’ problem (not enuresis, which is subject to an upcoming NICE guideline) but statistical significance is only the first problem in deciding if something actually works. This post takes up the challenge of not just saying that something is likely to work, but just how well it works. […]
What about benefits?
It’s worth taking some time to return to basics every now and again, and one thing that continues to befuddle medics the world over is the issue of ‘statistical significance’. […]
Do children and adults really differ?
@giordanopg recently tweeted a link about a paper in pre-publication from The Journal Of Pediatrics. It’s an analysis of a bunch of Cochrane reviews that had both child and adult RCTs included in a meta-analysis and asked the question “Do children and adults really differ?” Their technique was to compare the key outcomes by comparing […]
What would Jack want?
Or perhaps it should be ‘What would Mohammed want?’, or Alyx, or Devine, or Vladimir … when we’re asking clinical questions, do we really think what outcome our patient and family want, or do we just think what we think they would want? To put it another way – how close are the outcomes that […]
FAST appraisals
I’m fairly sure you’ll remember the RAMbo method of reviewing the validity of single randomised controlled trials. And so I think that many readers will have been having sleepless afternoons, struggling through the lengths of a ‘User’s Guide’ checklist for systematic reviews thinking “Which action hero can rescue me from this mire?”. Or perhaps not. […]
Trials are not needed
Sometimes, EBM is accused of being slavishly devoted to the Randomised Controlled Trial. This is clearly garbage if you look to answer a question outside of therapeutics: see our Archi posts on diagnosis and prognostication, for example. But even within the setting of picking the right treatment for the patients you see, the RCT is […]
Finding the question
It’s one of the tenets of the evidence-based practice process that questions are framed as ‘PICO’: patient, intervention, comparison and outcome. But what happens when the question is bigger than PICO? […]
Move over reading, ‘riting and ‘rithmatic …
“The 3Rs are dead; long live the 3Rs.” So might a herald cry from the battlements of an evidence-based hill. Sharon Straus and Brian Haynes have captured beautifully the need to move beyond just publishing your paper to making evidence available that is ‘reliable, relevant, and readable’. Why these three Rs? […]