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Towards evidence based medicine for paediatricians
  1. Bob Phillips
  1. Evidence-based On Call, Centre for Evidence-based Medicine, University Dept of Psychiatry, Warneford Hospital, Headington OX3 7JX, UK; bob.phillipsdoctors.org.uk

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    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.1Archimedes 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. In doing this, we are adapting a format which has been successfully developed by Kevin Macaway-Jones and the group at the Emergency Medicine Journal—“BestBets”.

    A word of warning. The topic summaries are not systematic reviews, through 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 They make no attempt to statistically aggregate the data, nor search the grey, unpublished literature. What Archimedes offers are 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 Sackett5 and Moyer6 may help. To pull the information together, a commentary is provided. But to make it all much more accessible, a box provides the clinical bottom lines.

    Electronic-only topics that have been published on the BestBets site (www.bestbets.org) and may be of interest to paediatricians include:

    Does intranasal or oral sumatriptan effectively relieve migraine headaches in adolescents?

    Do we need to give steroids in children with Bell’s palsy?

    In the paediatric population, should minor mucosal tongue lacerations be sutured?

    Topical anaesthetic or lidocaine infiltration to allow closure of skin wounds in children?

    How useful is ultrasound in the diagnosis of testicular torsion?

    Readers wishing to submit their own questions—with best evidence answers—are encouraged to review those already proposed at www.bestbets.org. If your question still hasn’t been answered, feel free to submit your summary according to the Instructions for Authors at www.archdischild.com. Three topics are covered in this issue of the journal.

    Is polyethylene glycol safe and effective for chronic constipation in children?

    Are antiemetics helpful in young children suffering from acute viral gastroenteritis?

    Should aciclovir be prescribed for immunocompetent children presenting with chicken pox?

    REFERENCES

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    Footnotes

    • Bob Phillips

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