Archive for the ‘Reviews’ Category

Proning – Is it worth the hassle?

Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis

Appraiser: Dr Andrew Langton Continue reading


The Pinocchio Effect

An interesting editorial published a couple of months ago in Anaesthesia by Neil Soni. It adds to the growing disquiet that our understanding of disease, and attempts to find effective remedies, are being hampered by the tendency to treat all organ failures equally. I agree that there seems little reason to believe that meningococal sepsis in an 18 year old will behave the same as peritonitis in an 80 year old, nor that ARDS following pancreatitis is the same as that following FFP. However, these syndromes were designed partly to make research into rare presentations possible. If we define patients according to causative factor and co-morbidity how are we ever to recruit enough to power even the most basic trial ?

ARDS, acronyms and the Pinocchio effect. Soni N.Anaesthesia. 2010 Oct;65(10):976-9. doi: 10.1111/j.1365-2044.2010.06508.x.PMID: 21198467

Post Publication Peer Review

First an apology, there’s been quite a gap since my last post. I will be trying my best to increase the frequency of appraisals on Critical Insight, especially since Schringer & Altman’s editorial in this week’s BMJ. They comment that the “lack of post-publication review of medical research is a sign of an unhealthy research environment in clinical medicine”, and that “we need a change in culture to value public discussion”, I couldn’t agree more.
The major journals have a vested interest in suppressing critical appraisal of published papers as this tends to undermine their pre-publication peer review, a process that has failed to prevent publication of flawed research and in any case adds little to clinicians ability to apply that research. Letters to the editor are limited, screened by the same process that published the original research and significantly delayed. Apart from the BMJ other major journals have not embraced post publication discussion, although there are other sites that are filling the gap, for instance F1000 (conflict of interest – I have also published appraisals for this site).

Critical Insight was started to help fill this post publication review gap, and your help in the form of comments and posts is always welcome. To that end I’ve removed the need to be signed in to comment, if you can see the site you should be able to post a comment.

Physiological Effects of Hyperchloraemia and Acidosis

Physiological Effects of Hyperchloraemia and Acidosis. Handy, JM & Soni, N. British Journal of Anaesthesia. 2008, 101(2):141-50.

Useful or interesting review articles & editorials will be flagged on the site from time to time. This is an interesting physiology review article challanging a few widely held views…..

Dr Dan Harvey