Negative outcomes in critical care trials: applying the wrong statistics – or asking the wrong questions?

Pre‐operative SARS‐CoV‐2 testing, isolation, vaccination and remote prehabilitation – the road to ‘COVID‐19 secure’ elective surgery

“…First, many might be unpersuaded that an independent association between a short period of isolation and the incidence of postoperative pulmonary complications is biologically plausible [ 11 ]. Second, those who isolated may have also shielded before isolation.…”

The evolution of evidence‐based medicine in critical care: have we left ‘time to defecation’ behind?

“…Increasingly, however, as understanding of trial design and research methodology improves, together with advances in clinical standards, it is becoming more difficult to show 'a difference', even for interventions that have lost equipoise, such as respiratory venovenous extracorporeal membrane oxygenation [7]. Couple this with the fact that most new advances offer modest incremental benefit at best [8], together with issues around asking the right questions and employing the correct statistics [9], and evidence‐based medicine might look set to paint itself into a corner. The point is illustrated by comparisons between constipation in critically unwell patients and delirium in the same cohort.…”

“…They included data from 396 patients, of which 60 (15.2%) passed no stool during their stay. The median (IQR [range]) time to defecate was 6 (4-8 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]) days. Following multivariate analysis, the use of non-invasive ventilation and duration of mechanical ventilation were independently associated with longer times to defecation.…”

Beta errors in anaesthesia randomised controlled trials in which no statistical significance is found: Is there an elephant in the room?

“…21, 25, 26 Conclusions of clinical superiority related to statistically significant results also require scrutiny, and should be interpreted with attention to the clinical relevance of the observed effect, 26, 27 and in the light of prior findings. 28 –31…”