Back in the days when junior doctors worked a 1:3 (1:2 when one of you decided to go on holiday), there were only two dieuretics and antibiotics used to kill bacteria, we learned our trade by hard graft. I (honestly) can’t remember the number of lumbar punctures I’ve performed, but I am aware that it’s […]
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What’s in a name?
Much of the time I’m called Ian, and at others I’m called Dr Wacogne. I do get called some other things, but I can’t write them here. We’ve just greeted a new group of foundation (intern) doctors, and I have, as ever, entirely befuddled on them by emphasising that I am Ian, at all times […]
GRADE it.
As mentioned quite some time ago, there are a number of ways of approaching the ideas of indicating the strength of evidence behind recommendations. Archi has stuck with a rather old, but easy-to-follow version from the Centre for Evidence Based Medicine in Oxford. During the decade of Archi’s existence there’s been the steady development of […]
Another brick out of the wall.
Unpopular things are tricky, aren’t they. Like saying “Abstinence programmes for sex education don’t help reduce unwanted pregnancy” or “dummy use in babies reduced SIDS and didn’t really cause funny teeth “. Here’s another one – breast feeding probably doesn’t reduce obesity rates in later childhood. The results of an 11 year follow up of […]
Credit where it’s due – fanfares for negative results
We’ve mentioned before the use of trial registries and the need to publish all trials, and also the trouble with trying to get negative stuff out into press. Archi would like to hand out a gold star in this regard. […]
Learning how to fail. Safely.
There’s a great TED talk by Brian Goldman called “Doctors make mistakes. Can we talk about that?” After a pre-amble which is pretty North American – baseball stats, which he makes thankfully very clear to those of us who simply don’t get it – he describes the fact that he makes mistakes in his medical practice. […]
Just looking at it again.
Systematic, meta-analytic, comprehensive, rapid, short-cut, traditional, scholarly, critical, scoping, mapping or mixed? How many words do we need to describe reviews? 14 (disappointingly) […]
Worried about sepsis. Very worried.
I have spent my entire professional career giving boluses of fluid to patients with septic shock, from the very first paediatric patient I met on call (“You’re the paed? We need you, this lad’s sick.”) through imprints of 50ml syringes squeezed into infants to over-the-phone requests to run another 500 ml of saline in while […]
Thas nowt so blind as ’em that won’t see
The RAMbo acronym that Archi first chattered on about five years ago relied on the key suspected elements of risk of bias – the need for randomisation, accurate ascertainment of outcomes in the groups to which people were randomised, and being careful of measurement – thinking about what was actually measured and if it was […]
Missing. Presumed suppressed.
The last few years have seen clarity in the emergence of an insidious and tainting perversion of the truth through data obfuscation, suppression and misalignment. The challenge of unseen trials has been addressed in a number of ways; probably the best of these are the insistence on all trials in human subjects being prospectively registered with their […]