In a recent flurry of twittering, Archimedes noticed a meta-analysis linking chorioamnionitis with necrotising enterocolitis. Although a long time since doing neonates has passed, the consequences of NEC were profound enough to stick, and a potential association, perhaps a route in to stopping it happen, would be welcome. The meta-analysis showed that, on univariate examination, […]
Category: archimedes
New way to wee
There’s a paper in the Archives from January which presents a ‘new’ way of collecting urine from little babies. (I say ‘new’ as it is startlingly similar to the method employed by the Matron at my first SHO appointment, back in the last millennium, but this version is scientifically tested.) How should we, as clinical […]
Proof of equipoise
In order to test a new treatment, in a standard randomised controlled trial, we are ethically assumed to have ‘equipoise’: an honest uncertainty at the same chance of a patient being allocated to the new or old treatment. But, I hear you scoff, how can any investigator put themselves through the hell of ethical administration […]
When is it obvious?
Most of us agree that the fairest and more objective way to test if a treatment works is the randomised controlled trial (RCT). We may also agree that there are situations where a RCT is not feasible, practical or ethical, or situations where the effect is so obvious that you don’t need to test it. An […]
Cracking the mould
While Archimedes does, not infrequently, get all concerned about invasive fungal infections, this post is not of the issue of beta-D-glucan testing, or problems of azole interactions. Instead, its a swipe at the problem of how, given a transparent system of asking questions, acquiring information, and appraising the evidence we can come to such […]
Should Archimedes be exiled?
Well … it never happened in antiquity. Archimedes got killed by an invading soldier. But back to Archi in the ADC – should we abandon this column as the articles are not ‘proper’ systematic reviews, or is a good short-cut review nearly as good as a 12-month long ‘full’ review? This is, as you would […]
It’s all the same
I am regularly faced with questions comparing two management approaches, and sometimes struggle to work out if the data which supports them shows that one thing is better, one thing is maybe not better, but not worse, that the two things are the same, or that we can’t really tell what the differences might be. […]
Tarnished gold
What can you do when a ‘gold standard’ isn’t actually that good at diagnosing a condition? It can be terribly problematic in interpreting sensitivity and specificity – for example comparing polymerase chain reaction diagnosis of microbiological infection with culture results. The ‘false positive’ may actually reflect real, and otherwise missed, diagnosis, and the ‘false negatives’ […]
Short-cuts to effectiveness information
A while ago Archimedes reviewed the benefits of using ‘pre-appraised’ search resources, short-cuts to the best methodological quality evidence to answer clinical questions. The favoured database of many, PubMed [www.pubmed.gov] has now receieved a new addition to the range of resources on offer. […]
When is a result not a result?
Hot on the heels of this great Archimedes on whether or not you should routinely do an LP in infants with a urinary tract infection, comes another publication, covered with a fairly critical review in Journal Watch. What’s fascinating here is both “sides” drawing a conclusion that they can’t draw. […]