Towards evidence based medicine for paediatricians
In order to give the best care to patients and families, paediatricians need to integrate the highest quality scientific evidence with clinical expertise and the opinions of the family.1 Archimedes seeks to assist practising clinicians by providing “evidence based” answers to common questions which are not at the forefront of research but are at the core of practice.
A word of warning. The topic summaries are not systematic reviews, though they are as exhaustive as a practising clinician can produce. They make no attempt to statistically aggregate the data, nor search the grey, unpublished literature. WhatArchimedes offers is practical, best evidence based answers to practical, clinical questions.
The format of Archimedes may be familiar. A description of the clinical setting is followed by a structured clinical question. (These aid in focusing the mind, assisting searching,2 and gaining answers.3) A brief report of the search used follows—this has been performed in a hierarchical way, to search for the best quality evidence to answer the question.4 A table provides a summary of the evidence and key points of the critical appraisal. For further information on critical appraisal, and the measures of effect (such as number needed to treat, NNT), books by Sackett et al and Moyer et al may help.5 6 To pull the information together, a commentary is provided. But to make it all much more accessible, the clinical bottom line is highlighted.
Readers wishing to submit their own questions—with best evidence answers—are encouraged to read the Instructions for Authors athttp://www.archdischild.com
Critical appraisal note: evidence of equivalence versus no evidence of difference
When a randomised study compares two therapies and finds no difference in an important outcome between the two, does this provide evidence of equivalence or merely an absence of evidence of effectiveness? …