{"id":1462,"date":"2019-05-16T21:28:33","date_gmt":"2019-05-16T20:28:33","guid":{"rendered":"https:\/\/blogs.bmj.com\/adc\/?p=1462"},"modified":"2019-04-27T10:33:03","modified_gmt":"2019-04-27T09:33:03","slug":"cut-once-measure-twice","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/adc\/2019\/05\/16\/cut-once-measure-twice\/","title":{"rendered":"Cut once, measure twice"},"content":{"rendered":"

\"\"As every child health practitioner knows, children’s telly is awash with moral learnings, repetitive messages and ear-worms. It can be a superb tool for the education and distraction of poorly children, and irritating barrier to bedtimes and homework, and a torture-device … try humming “Baby Shark” when you next go for your team coffee\/drink and watch how faces contort as brains are over-run …<\/p>\n

One of those ear-work messages was “Cut it once but measure twice, it always pays to be precise”. I’ve found that to be very useful in home improvements (particularly shower-screen runner-sizing) and also in understanding therapeutic trials. Would you go and book a holiday based on a conversation on the stairs, or a single TripAdvisor posting? What about a review from the resort’s own website? Mostly we’d look for repetition, an ability to confirm the information. Perhaps from a different perspective, or tales from those who’d been somewhere close. Maybe the only time we’d go on one recommendation would be if it was from a friend whose taste in holidays matched ours own, had photographic proof, and was well within our budget?<\/p>\n

The same applies to therapeutics. And is built into the GRADE approach<\/a>. What’s the inherent believability of the information? How is it likely to be influenced and diverted from The Truth? Is this an overwhelmingly big result, one so impressive it really can’t be a fluke? How close does the study match what you’re wanting from the intervention – the patients included, the outcomes they examined? Is this a one-off or repeated, with greater precision and confidence in the results? Risk of bias, size of effect, directness and critical-outcome, consistency of results and precision of estimates of effect may be the ‘proper’ terms but they refer to elements we can all get behind to understand. Don’t let publication in a major journal take away your common sense ability to assess.<\/p>\n