Pain is one of the most distressing symptoms children living with cancer experience. It can be caused by the disease, procedures and side effects of medication. Pain can be pervasive and impact every part of a child with cancer’s life. Managing this pain has been shown to have a profound impact on a child’s health […]
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Using the power of pathology
Back in the mists of pre-clinical training, I used to believe that disease states arose through disordered bodies. That illness was a disturbance of anatomy and physiology, and that by understanding the basics of normal, we could derive the pathological, and so predict the disorder and define the therapy. Then I learned of the influence […]
Incongruous
I’ve struggled with spelling for most of my life and in still occasionally do pronouncing terribly wrong. (For about 4 books, I pronounced Hermione “Hermy-one” in my head, instead of “Her-my-oh-knee”, for example.) So every time I see the word ‘incongruous’ I tend to get slight shivers of spelling-test related fear. It is, however, a […]
Spirals of re-validation
In the UK, revalidation, to the eyes of anyone in a permanent post, brings thoughts of GMC pleasing e-paperwork and the joy of yet more hours staring at a barely functional system to prove you are safe and sensible enough to not play with computers but auscultate bunnies (where necessary) and diagnose life-threatening disorders. To […]
You can’t unknow it …
A pal of yours is told at a conference by a slightly drunk principal investigator about a drug trial, that’s been first-pass data cleaned and a basic analysis undertaken. The results are clear … even given the possibility of the effect shrinking with more complex adjustments … giving Drug A (the experimental use of an otherwise […]
Backing off
I know we’ve been away for a bit, and there are loads of good reasons (life, and that sort of stuff) but we are all sneakily hoping you are all still interested about how to put clinical evidence into clinical practice. In The Gap there has been much written and spoken about the problems of […]
Shared decision making
So the model of EBM that we espouse is one grounded in the patient ‘dilemma’ being the start and end point of the process. You’ll recall it’s a patient’s situation that triggers the asking of a PICO question, and particularly the selection of patient-oriented outcomes are vitally important. The acquisition and appraisal of studies that […]
Can our children’s trials work better than they do?
We’re all well aware of the problems of doing randomised clinical trials in paediatrics – small numbers, uncertainty about sample size estimates, lack of funding to undertake the studies – but are we as aware of some alternative approaches that have been used [1]? “Sequential design” studies look at comparing a series of treatments against […]
Damned if you do, damned if you don’t?
The field of systematic review, of which Archimedes we believe sneaks in under the ‘rapid review’ heading, has long since held a solid foundation to what a systematic review needs to do. It needs to have a clear question, with a comprehensive search, and assessment of included studies bias / quality, a synthesis (which may be mathematical; […]
MiniStatsBlog: Making decisions from numbers
It’s a thing we like to do in medicine – make decisions on the basis of numbers. The temperature is greater than 38C in a neutropenic child? Start antibiotics. The CRP in your snuggly neonate has reduced? Stop antibiotics. The PEWS score is high – review. Lots of researchers want to help out with this too, […]