Best Evidence Topics


Tow A,
Oral dexamethasone in Insect Bites:
The West Virginia medical journal,
(1966) 62 (6): 161-62.
  • Submitted by:Tanzeem Iqbal - Medical Student
  • Institution:Manchester Royal Infirmary
  • Date submitted:20th July 2005
Before CA, i rated this paper: 5/10
1 Objectives and hypotheses
1.1 Are the objectives of the study clearly stated?
  no, there is no data as to how the information was collected
2 Design
2.1 Is the study design suitable for the objectives?
2.2 Who / what was studied?
  50 patients of all ages both males and females
2.3 Was a control group used if appropriate?
  no control group
2.4 Were outcomes defined at the start of the study?
2.5 Was this the right sample to answer the objectives?
  yes patients with bites and stings
2.6 Were patients at a uniformly early stage in their disease?
  yes, just been stung or bitten
2.7 If subgroups with important prognostic differences are already known were there adjustments made for these prognostic factors?
2.8 Is the study large enough to achieve its objectives? Have sample size estimates been performed?
  no , only 50 pateints and some were stings alone
2.9 Were all subjects accounted for?
  yes, but results did not show all subjects
2.10 Were all appropriate outcomes considered?
2.11 Has ethical approval been obtained if appropriate?
3 Measurement and observation
3.1 Is it clear what was measured, how it was measured and what the outcomes were?
  not at all, however, only the initial dose was shown , this was 6 mg, and it was not stated how many repeat doses were given to improve symptoms of insect bites and stings
3.2 Was the assessment of outcomes blinded?
3.3 Was follow up sufficiently long and complete?
  short and incomplete
3.4 Are the measurements valid?
  yes, as symptoms improve after administration shows that oral dexamethasone worked
3.5 Are the measurements reliable?
  not reliable because the improvements in symptoms were over different times, maybe the improvement should have been measured over a fixed period of i.e 24 hours. Results were not clearly specified
3.6 Are the measurements reproducible?
4 Presentation of results
4.1 Are the basic data adequately described?
4.2 Are the results presented clearly, objectively and in sufficient detail to enable readers to make their own judgement?
  not at all, results from only 9 cases out of the 50 were published, these were in the form of mini reports
4.3 How large are the effects within a specified time?
  very large
4.4 Are survival curves presented?
  none, very poor
4.5 Are the results internally consistent, i.e. do the numbers add up properly?
  no numbers to add up, statistical analysis is absent
5 Analysis
5.1 Are the data suitable for analysis?
5.2 How precise are the prognostic estimates?
  not mentioned
5.3 Are the methods appropriate to the data?
  methods not clearly stated. therefore difficult to answer
5.4 Are any statistics correctly performed and interpreted?
  none at all. lacking
6 Discussion
6.1 Are the results discussed in relation to existing knowledge on the subject and study objectives?
  no, only a conclusion
6.2 Is the discussion biased?
7 Interpretation
7.1 Are the author's conclusions justified by the data?
  yes, oral dexamethasone is reliable for treatment of insect bites
7.2 What level of evidence has this paper presented? (using CEBM levels)
  not a good level
7.3 Does this paper help me to answer my problem?
  partly, not a good quality paper. does not suggest whether the drug reduces inflammation, but suggests that it is reliable, however it can be concluded from the results that symptoms were releived.
After CA, i rated this paper: 3/10
8 Implementation
8.1 Can any necessary change be implemented in practice?
  continue providing clinical care based on clinical judgement until supportive evidence is available.
8.2 What aids to implementation exist?
  loook at case reports, if no hard evidence exists. then carry out trials to compare steroids vs no steroids in reducing inflammation following insect bites and stings
8.3 What barriers to implementation exist?
8.4 Are the study patients similar to your own?
  the paper uses patients of all groups, mine were adults only
8.5 Does the paper give any conclusions that will affect what you will offer or tell your patient?
  yes, steroids are reliable to releive symptoms