As junior doctors, we often feel there is no time to effect change in a short rotation through a department. Having taken time out of training, I have had the opportunity to witness how change can, and does happen within the NHS. I’ve observed how one inspirational consultant working a rural DGH had the vision […]
Latest articles
Refreshing
Every now and then you’ll hit an EBM question, clinical dilemma or situation where you’ve got it at the back of your mind, or the tip of your tongue, you’ve seen something similar before. It may be a network meta-analysis, where people seem to have combined studies in a spidergram not a forest plot. A […]
Underrepresentation
Not uncommonly, the issue of the generalisability or representativeness of a study population to the ‘real world’ is raised. There are some pretty big issues here, not least the idea that studies are undertaken in an unreal world, where troubles melt like chimney tops and sail above your lemon drops. Avoiding those sorts of mangled […]
GUEST BLOG: The R Word
By Anna Baverstock Resilience has for many become an unmentionable word. It is also a ‘trigger’ word. Often generating an intensely negative reaction in some, that then negates anything that may be discussed after. My role as Associate Director of Medical Education (ADME) with responsibility for supporting junior doctors enables me to meet with many […]
Endocrinology is fun!
We hope that since the takeover of the @ADC_BMJ and @ArchivesEandP accounts by our social media team, you’ve enjoyed (and learnt something from) the flurry of thematic tweeting occurring each week as much as we have had generating them. The last week @ADC_BMJ has been focussed on the subspecialty of paediatric endocrinology and diabetes, and […]
Questions too tricky to answer
One of the challenges in seeking evidence to aid a difficult clinical dilemma is decided what the questions which are amenable to study might actually be. There are elements of the triad of clinical expertise, best-available research and patient situation and preferences which can only be brought by the individuals. There was a quote from […]
Confounded
There’s a lot of confusion on confounding. We need to understand confounding when we try to use non-randomised studies to see if doing a Thing is going to produce more good than harm, or looking for risk factors we then will hope to influence to produce goodness. If we look at observational data on time-to-diagnosis […]
Early adopter or reckless fool?
As we bang on about almost endlessly in Archi, we know that evidence is only part of a clinical decision. The story also includes the patient and their family, and sharing the decision is key to good medicine. There is the third leg on the tripod though – clinician expertise. In the simple iterations of […]
More than the medicine
The end of our profession is nigh! Chatbots and AI and Hal (I’m sort of hoping that there are either very very old people, or pre-millennial film buffs reading) will take over the world! Doctors are needed no more! While this is mainly the news about diagnostic flowbots, it’s not just there we have computers […]
When is a therapy experimental?
We’ve said before that EBM is about using the ‘best available’ evidence, and that while we’d love all our treatments to be supported by large RCTs and systematic reviews, Archimedes is living proof that this often isn’t the case. Sometimes we’ll be in the situation where the treatment could be quite reasonably subjected to a […]