We reported some time ago that a review of Cochrane reviews (yes .. we are well aware of the meta-meta here ) looking at both adult and child responses to treatments showed, on average, that an intervention was equally as likely to be effective, or ineffective, in children as it was in adults. Like many averages, […]
Category: archimedes
Has anyone ever seen an academic title like this where the answer is “Yes”?
You know the sort – ” Is survival and neurodevelopmental impairment at 2 years of age the gold standard outcome for neonatal trials?” – have you ever seen one written where the answer is “Yes”? Go on … have a look and quote us some in the comments. – Archi […]
Measuring consentability
So I’m inventing words here. Could be worse though, could be “stooling” for “having a poo” or “pedagogy” for .. well, whatever you want it to mean when you really mean “be quiet and listen”. But how can you judge if a child / young person is sufficiently aware of ‘stuff’ to be able to […]
What moved you to move?
When was the last time you changed your behaviour? (I’m not talking here of speaking differently to your Mum in Urdu, your sister in Londoneese and your patient in Glaswegian …) When did you last decide “I am doing THIS/THAT thing differently from now on.” Got one? Right. Why did you do it? Take 30 […]
Ignore the platelet count in HSP if you’re wondering about kidneys
Every now & then you bump into something that makes your heart sing. For me, I sometimes struggle to come up with good examples of an ‘EBM’ tennet – for instance, the difference between statistical and clinical significance – which has an actual origin. Well, in a paper entitled Platelet Counts in Children With Henoch–Schonlein Purpura—Relationship […]
Deliberation and determination
What does it mean to have a choice in your care? It’s an interesting question, I think. And may not be as neatly answered as the pat response to an exam: “for example, let the child choose which book to look at while you do the venipuncture!. If you can’t influence the final yes / no […]
The crumbling of the pyramid of evidence
The ‘old way’ of thinking about the hierarchy of evidence was classically envisaged as a systematic review at the top, falling through RCT, cohorts and case-control to expert opinion (and below that, in some iterations, case law & legislative decisions). There’s been a move against this, with the GRADE system as explained recently in our popular […]
Always question your question
I was recently at a wonderful conference in Toronto, where 1900 folk interested in childhood cancer came together to learn, argue, network, present and be merry – #SIOP2014. There was a particularly interesting debate between two very clever oncologists about whether or not we should use antifungal prophylaxis in children with AML and post-stem-cell-transplant. (Both are […]
Guest post: The Systematic Review Speaks The Truth …… Or Does It?
A good quality systematic review should identify and synthesise all the available evidence, for a particular question, through meta-analysis. Conclusions can then be made about the effect of the intervention on the outcome. As, in theory, all the available evidence is gathered and assessed, surely the conclusions from the meta-analysis must be the truth and […]
Explosive!
Well, I thought that was a better title than ‘Volatility’ which, to be fair, is closer to what this meandering post is all about. When we’re struggling our way through medicine, we have to face all sorts of uncertainties. Some of these are the frank face of ignorance (we just don’t know something), some of […]