The basics of evidence based medicine are to ask a question, acquire a paper that might answer it, appraise the study, apply it’s results and assess performance. The appraisal bit can be done a few different ways – but underneath nearly all of them sits a similarity of key concepts – it’s just the gloss that varies. […]
Category: archimedes
Predictive Factors
Sometimes, we spot stuff that predicts how things will happen. Well, usually happen. These may be described as ‘risk’ factors – that is, factors which predict something will happen – or ‘prognostic’ factors – thinks that predict the outcome of a condition. There are a range of generalisations that are sometimes made from ‘predictive’ studies, […]
Stopping Rules
If you were cycling or driving, you’d probably know what the stopping rules were. Traffic not moving, big red sign, large goose with malevolent glare (Lincolnshire speciality). What if you’re doing a clinical trial? There are a variety of things what have been described, some of them are qualitative (SUSAR – sudden, unexpected, serious adverse […]
There are many ways to truss a duck
And there are lots of ways to do ‘synthesis’ of evidence within a systematic review. We’ve gone on – at length – about meta-analysis and described qualitative synthesis with meta-ethnography, but in a new paper in the Archives we see how a narrative combination of quantitative research studies with a qualitative framework to understand them can […]
Why are you measuring it like that?
We measure, monitor and assess lots of things in our jobs. We frequently try hard not to think about poorly reproducible some things are – take breathlessness in children as discussed in a recent blog – and the whole literature is methodologically far weaker than that of intervention research. Sometimes we’re really like to assess something, […]
Is breathlessness worth reporting at all?
Again, deliberate bait in the title which I do hope you’re all used to by now … But the question arose when I started to look at this paper published in the Archives, addressing the question of observer variation in clinical assessment of wheezy kids. Mostly, I think wheeze = mediastinal mass (fast onset -> T-cell […]
Guest Blog: The trials and tribulations of answering clinical questions
For a recent evidence based paediatrics assignment we had to answer and present a clinical question. I’m sure you are well acquainted with the process; construct your question in standard PICO format, search your secondary and primary sources, critically appraise the evidence and draw your conclusions. Having noted a trend towards starting lamotrigine rather than […]
Basics: Another way to look at it all
While the theory of different styles of learning (kinetic, verbal, visual etc etc ) may be thoroughly garbage it’s pretty much true that folk often prefer one way of getting their learning. Some like listening – catch our podcasts for that – others doing – so we have #ADC_JC – and many readers of this blog […]
Basics: Are you worrying about stuff?
I spend quite a lot of time fairly unsure that I really know enough about the stuff I should know about. Sometimes I think we could benefit from reflecting on this a bit: Are there known uncertainties – things which we have a good estimate, based on good research, but gives us an answer which isn’t […]
Critical interventions
There are considerable numbers of interventions which are undertaken at points of emergency; severe head injury, severe septic shock, myocardial infarction, admissions to intensive care units… In these situations it can be extremely tricky to get the critically ill, often unconscious, individual to agree to being randomised in a clinical trial. Yet without that, we won’t […]