A Bayesian analysis of mortality outcomes in multicentre clinical trials in critical care.

Background: Multicentre RCTs are widely used by critical care researchers to answer important clinical questions. However, few trials evaluating mortality outcomes report statistically significant results. We hypothesised that the low proportion of trials reporting statistically significant differences for mortality outcomes is plausibly explained by lower-than-expected effect sizes combined with a low proportion of participants who could realistically benefit from studied interventions.

Framing of clinical information affects physicians' diagnostic accuracy.

Background: Framing bias occurs when people make a decision based on the way the information is presented, as opposed to just on the facts themselves. How the diagnostician sees a problem may be strongly influenced by the way it is framed. Does framing bias result in clinically meaningful diagnostic error?

Methods: We created three hypothetical cases and asked consultants and registrars in Emergency Medicine and Internal Medicine to provide their differential diagnoses and investigations list.

Perioperative support of a patient with fat embolism syndrome with extracorporeal membraneoxygenation.

Fat embolism syndrome (FES) is a serious complication of trauma that can result in multiorgan failure, including the acute respiratory distress syndrome. Occasionally, the severity of respiratory failure associated with FES warrants support with venovenous extracorporeal membrane oxygenation (VV-ECMO), a therapy with widespread use but inconclusive evidence. Early definitive fracture fixation is the mainstay of preventing further fat embolism and ongoing organ dysfunction, but poses significant risks to the maintenance of the extracorporeal circuit.

A comparative MRI study of cartilage damage in gout versus rheumatoid arthritis.

Introduction: Magnetic resonance imaging (MRI) is useful for detecting joint inflammation and damage in the inflammatory arthropathies. This study aimed to investigate MRI cartilage damage and its associations with joint inflammation in patients with gout compared with a group with rheumatoid arthritis (RA).

Methods: Forty patients with gout and 38 with seropositive RA underwent 3T-MRI of the wrist with assessment of cartilage damage at six carpal sites, using established scoring systems.

Methodological quality of systematic reviews in subfertility: a comparison of two different approaches.

Background: Systematic reviews are used widely to guide health care decisions. Several tools have been created to assess systematic review quality. The measurement tool for assessing the methodological quality of systematic reviews known as the AMSTAR tool applies a yes/no score to eleven relevant domains of review methodology.