If you were offered a choice of medication to treat an ailment you were suffering from, and you’d asked about how effective they were (and there’s a huge chunk of the population that wouldn’t, and would be happy to just do as they are told), then what information would you like? […]
Category: critical appraisal note
Ask, and it might be given unto you.
The five steps of evidence based practice are commonly summarised as ‘Ask, Acquire, Appraise, Apply and Assess’. The first one of these – just asking a question – can prove terribly time consuming and difficult, but with a bit of dissection can be made much easier. The first step when deconstructing the anatomy of inquiry […]
Making science of art
In the window of the Wellcome Collection in London artists work to interpret and explain science: it’s an impressive experience to the irregular visitor. When faced with the presenting problems of a child & family, we are faced with trying to do the reverse. We have the sometimes inaccurate recollections of history, the variable responses […]
But at what cost?
It’s uncommon for us, as paediatricians, to be asked about how cost-effective our treatments are. Glancing at the media shows health stories about the new wonder drugs in adult cancer, or in Alzheimer’s disease, and how they are being restricted by a heartless and miserly health system. Where do these statements about ‘cost-effectiveness’ come from? […]
Disease spectrum vs disease prevalence
In examining a diagnostic test, we make the assumption that the characteristics of the test – its sensitivity and specificity (or likelihood ratios, the way I prefer to think) – will stay constant across different populations, although the positive and negative predictive values will change * . This is sort of true, and sort of […]
Crystal balls
It’s a great sport of journalists and commentators to look back at predictions of the future from decades past, and see just how badly they have gone astray. We do this as clinicians too, but with a sense of guilt … looking back to an unexpected relapse of a low-risk tumour, or a fulminant hepatitis […]
New things in evidence synthesis
The days of a meta-analysis being the simple adding up of lots of studies, pretending that they are all just tiny pieces of the One Big Trial that was performed before the world was made are on their way out. Newer ways of using synthesised evidence – like meta-regression and individual patient data analysis – […]
Fixing and Focussing
Imagine the situation: you’re in a clinic and in comes a 7 year old child with a belly ache. The ache has been there, on and off for 3 years. Investigations have been undertaken for at least 2 years, in two different centres, and have included blood, stool, radiological and invasive procedures. No clear diagnosis […]
Remember Rambo?
Back in 1982, when some of the readers of this journal were being tucked up in bed, others were doing the tucking-up and yet more had already fallen asleep in their armchairs, Sylvester Stallone wandered half-naked around the outskirts of a fictional US town in the film “First Blood”. However, this memorable character (John Rambo) […]