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 […]
Category: therapy
I can’t intubate .. can I have a mask?
Not to obscure your deeply shamed face (I know, I’ve had it happen …) but a laryngeal mask, one of those disturbing bits of equipment anesthetists use when the operations’s not long enough to enjoy a nice cup of tea during an operation. Can an LMA be a reasonable choice in neonatal resuscitation? […]
Clean your hands! And wash your stethoscope while you’re at it.
It’s now been some years since I’ve felt comfortable working with the feel of soft cotton on my elbows. Even when not in a designated clinical zone, its sort of wrong. Anyway, after the success of ‘wash your hands’ decade in making millions of people have cracked, sore skin, there’s a thrust to the obsessive […]
Why the obsession with Vitamin D?
So, in the dark and cold climes of an early Northern Spring, Archi has been assailed by questions of vitamin D. There are, it is claimed, near-miraculous things from Vitamin D sufficiency – less cancer, less heart disease, less rickets. Well, I’ll buy the last one, but the others? And does any child really need […]
Many outcomes give no answer?
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’. […]
Q: Who’s still prescribing 0.45% saline for rehydration?
Me … well, actually I don’t anymore, but that’s mainly because I don’t do rehydration. I tend to do hyperhydration to stop the methotrexate causing any more damage than I know it’s going to. BUT if I did prescribe any fluids for a dried up sprogling, I’d reach for 0.45% saline with a sniff of […]
Q: Should you test Asian patients for HLA-B*1502 before presecribing AEDs?
I think this is a fascinating question. In paediatric oncology, we’re been doing a tiny bit of genetically personalised medicine for a while now, testing the allelic variations of thiopurine metabolisers so we don’t (over~) poison a small proportion of children with ALL. There are suggestions […]
Motherhood, apple pie, psychosis and anaphylaxis
I’ve been worrying about this for some time now. How should we, as health professionals, address the deeply held beliefs of our patients when they aren’t true? Especially when they may harm others, although in a fairly obscure or indirect way? […]
Novelty or reality?
There’s a rather old study of playground renovation that’s been re-circulating recently (via Twitter, via @drbengoldacre and @cebmblog) which claims to demonstrate that really fancy multicoloured markings in primary school playgrounds get kids moving much more. […]
Q: Carbamazapine calms you down?
Despite being a paediatric oncologist in my spare time, I am aware that brain tumours and neurosurgeons aren’t the only cause of acquired brain injury in childhood. And I know that the problems of ABI can be tremendous, from the horror of the initial injury and ICU, facing mortality and physical changes, through the unpredictable […]