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Evidence-based medicine

Intranasal Fentanyl for Paediatric Pain Control

24 Sep, 15 | by BMJ

Ken MilneBy Ken Milne

An eleven year-old girl falls while playing football. She presents to A&E with a painful wrist, and you suspect a fracture. Prior to her going for x-rays you wonder what you can give for pain management.

This is a common dilemma which highlights why paediatric patients are at greater risk of oligoanalgesia – the lack of, or inadequate, pain control. For example despite earlier RCT evidence finding ibuprofen alone may not be effective pain relief for children with musculoskeletal injuries, a recent retrospective study found it still to be the analgesic most commonly given, albeit this was set in a single emergency department.

However, there are many options available to treat paediatric pain both pharmacologically and non-pharmacologically. Sucrose, possibly combined with warmth, has been shown to be effective at reducing pain in newborn infants undergoing single painful events such as heel stick or vaccination. And music has been shown to have some benefit in children aged 3-11 undergoing intravenous catheter placement.

When considering ‘stronger’ pharmacological treatments, intranasal fentanyl (INF) is one which is of particular interest as the route of administration is likely to cause minimal distress. But can INF be used in paediatric patients to safely help control pain? more…

Standing in the shoes (paws) of patients to improve care

20 Aug, 15 | by BMJ

RDeanBy Rachel Dean

The application of the principles of EBM has been challenging the human healthcare system for a number of years. It has now been suggested that EBM is ‘in crisis’ or there is a need to alter the way evidence is presented to and implemented by decision makers. More emphasis needs to be placed on the ‘personal’ side of medicine to ensure patients receive optimal care rather than a curse of guidelines. Perhaps a sideways glance at the current status of EBM in the veterinary profession could help all creatures – great and small, hairy and feathered, two and four legged. more…

Running with the bulletins – a view from Pamplona

30 Jul, 15 | by BMJ

David P. photoBy David Phizackerley

Pamplona 2015 – The General Assembly of the International Society of Drug Bulletins (ISDB)

At the end of June, the city of Pamplona was getting ready to celebrate the fiestas in honour of San Fermin, the patron saint of Navarra, and the week long challenge of the encierro (running of the bulls). Much ceremony and excitement surrounds this relatively short run of 825m that typically lasts 4 minutes as the bulls charge from the corral in Calle Santo Domingo to the bullring. The risks to human participants are well known and each year, of the 20,000 people who take part, 200-300 are injured (1-1.5%) and there have been 16 deaths since 1910 (0.15 deaths/year). The benefits of participating are harder to determine but would probably be best described using a composite endpoint of relief, satisfaction and elation. Those who want to make an informed decision on taking part can easily find statistics on the harms and view television recordings of the event to see what happens to those who do run with the bulls. more…

Genetics and Personalized Medicine: Where’s the Revolution?

23 Jul, 15 | by BMJ

By Tim CaulfieldTimothy Caulfield

I started my academic career in the early 90s working on the policy issues associated with something called the “genetic revolution”, which we were constantly told (by researchers, government and the media) was just around the corner. As a result of this impending seismic shift, we needed to ready ourselves for all the profound social implications – or so the story (and the arguments for grant money) went.

Since then, the claims that we are in the middle of a genetic revolution have come at a steady pace, but the nature of alleged, near-future, healthcare transformation have evolved. First it was going to be gene therapy (it didn’t really pan out as planned). Then it was highly predictive disease genes (ditto). And now the revolution has taken the form of personalized medicine, also known as personalized genetics, personalized genomics or, in accordance with the latest semantic tweak, precision medicine. more…

The Skeptics’ Guide to Emergency Medicine (SGEM)

16 Jul, 15 | by BMJ

By Ken Milne

Ken Milne

“It takes 50 years to get a wrong idea out of medicine, and 100 years a right one into medicine”. (Dr. John Hughlings Jackson – British Neurologist)

Dr. Jackson’s quote points out how long it can take for knowledge translation (KT) in medicine. More recent data suggests it can take an average of 17 years for 14% of medical information to reach the patient’s bedside.

This is far too long in the age of social media. Don’t panic! The goal of the Skeptics’ Guide to Emergency Medicine (SGEM) is to shorten that KT window down from over ten years to less than one year. more…

BMJ Clinical Evidence – putting evidence in context

18 Jun, 15 | by BMJ

By Caroline Blaine

Caroline Blaine


BMJ Clinical Evidence is now 16 years old. Those in the UK and North America may remember the handbook – initially pocket size it grew over the years as new topics and new evidence were constantly added. Clinical Evidence is now very much an online resource offering a unique systematic overview of the current evidence base for common clinical conditions. This is combined with our tools to practise, learn and teach evidence-based medicine making it a go to place for clinicians, researchers and students. more…

A brief introduction to the concept of Evidence-Based Research

7 May, 15 | by BMJ


by Hans Lund

The scientific ideal
On 15th of February 1676, in a letter to his colleague (and rival) Robert Hooke, Sir Isaac Newton wrote the following well-known sentence: “If I have seen farther it is by standing on the shoulders of giants”. Newton referred to influential scientists before him such as Copernicus, Galilei and Kepler and emphasised one of the fundamental aspects of science – science is cumulative with each new discovery dependent on previous knowledge. more…

The way forward from ‘rubbish’ to ‘real’ EBM in the wake of Evidence Live 2015

24 Apr, 15 | by BMJ

by Huw LlewelynHuw Llewelyn

At Evidence Live, Iona Heath (video) reminded us that EBM should not interfere with wisdom and common sense. Trish Greenhalgh (video) gave a hilarious example of ‘rubbish EBM’ when a ‘falls protocols for elders’ was invoked after she went over her bicycle handlebars at speed! The answer is to arrive at initial impressions and decisions based on one’s current knowledge and then AFTERWARDS to check them against transparent reasoning and evidence. more…

An EBM Challenge: When randomized trials are difficult, and belief is strong and hopeful

16 Apr, 15 | by BMJ

The case of so-called “moderate” drinking

by Richard Saitz

It is “bad” enough when we have randomized trials to guide practice. What I mean is, of course solid consistent evidence from numerous trials should be used to inform practice, but even then it is challenging: do the benefits outweigh the risks? Do the benefits in tightly controlled trials persist in practice? more…

Addressing gaps in evidence

9 Apr, 15 | by BMJ

?????????????????????????????????????????????????????????????????????????Evidence-based medicine (EBM) is an approach that—in addition to clinical experience and patient preferences—takes into account existing research evidence to draw conclusions on the best approach for the care of individual patients. It is a key tool for clinical decision making as the need to balance research, new tests and treatments, and available resources with clinical experience and patient requirements continues to be an important focus in healthcare. more…

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Clinical Evidence is a database of systematic overviews on the effectiveness of key interventions, together with tools and resources to learn and practise EBM. Visit site

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