CONservative TReatment of Appendicitis in Children: a randomised controlled feasibility Trial (CONTRACT) , Hall, Crawley et al, 2021

Definitely. They show absolutely no compunction about openly contradicting themselves as long as the outcome is the same. They get to control what "care" someone gets. Most usually denial of care if it's any other discipline than psychological medicine.

 

Maybe this is what's behind the BPS craze claiming that 60% (or whatever made-up number) of GP visits are due to all-in-the-mind symptoms. Maybe they want a CBT therapist - or, heck, why not the receptionist - to be authorised to deny you the ability to even get an appointment based on any "risk factors" like history of depression/anxiety or thickness of medical file.

 

one of our our gp receptionists is pretty good at thids already- the knack is knowing when she is not on ...

 

I can't remember who said it but one of the prominent BPSers basically said exactly this, that they should be the frontline staff, even before triage, to "catch" psychosocial problems and steer them out of the medical path even before they see a physician. I'm thinking Sharpe but probably wrong, anyway it was someone pretty prominent. It was pretty much in exactly those terms: a psychological triage before the medical triage.

What a massive disaster this would be, but it does reveal their thinking and it's all about costs, nothing but resource management.

 

Just tidying up my collection of random findings in my drafts folder and stumbled across a possible explanation for EC's interest in appendicitis and her general fondness for trials with the prefix 'feasibility' and 'cost-effectiveness':

https://www.bristol.ac.uk/media-library/sites/social-community-medicine/documents/FINAL_C-II hub advisory report_2018.pdf

"The MRC ConDuCT-II (Collaboration and innovation for Difficult and Complex randomised Controlled Trials In Invasive procedures) HTMR aimsto develop into a centre of excellence for high-quality, cutting-edge methodological research of relevance to pragmatic randomised controlled trials (RCTs) in general, but with a particular focus on the needs of RCTs in surgery.

"It is a multi-disciplinaryteam based in the Bristol Medical School, Population Health Sciences,University of Bristol [...] The Hubis supported by a grant of £1,921,689 over five years, which was activated in April 2014."


The Hub has four research themes:

1 -Prioritisation and design of trials for cost effectiveness analysis

2 -Integrative and dynamic research methods to optimise recruitment to RCTs

3 -Improving Feasibility study designs And Conduct to enhance Trial quality and results (FACT).

4 -Outcomes in RCTs: selection, reporting and integration in decision making.


"Committee feedback emphasised that although all Hub members are not doing surgical trials methodology, it is a special part of the Hub that should be continued as a flagship theme."

 

We have discussed this in previous thread(s) I think. The University of Bristol has this group and possibly another relating to clinical research and the University’s associated publicity highlight Prof Crawley’s work with ME and her research in general suggesting she is a national or even international leader in understanding the use of RCTs in clinical trials.

It seems that Bristol has invested a lot of their reputation in supporting her work.

 

I automatically judge the institutions that support BPS work. Their reputations are damaged beyond repair to me.

 

given that she is neither the primary nor senior author, it is possible she just contributed some data or had some subsidiary role. I haven't checked the statement of who did what, if there is one, but I wouldn't assume automatically she had huge input into how the research was conducted, unless otherwise noted. that said, anything she touches is liable to be highly problematic.

 

Yes. I posted the document here because it may indicate that EC's research topics seem to be influenced also by Bristol Uni's infrastructure.

Not able to assess the quality of the appendicitis study and EC's role in it, also not able to assess the concept of the "hub" within this and also EC's research on Lightning Process and MAGENTA seem to be somehow part of.

Just wanted to point out that there is that infrastructure where EC's research is done within. And that infrastructure seems to support her work and to prioritize feasibility and cost effectiveness as topics over other topics.

In addition, with regards to the study discussed here, it felt somehow odd to me to denote a subject for medical research a "flagship" theme. (see my quote above).

But as @Peter Trewhitt said, that probably has been discussed on another thread already.

 

Interesting article
Note the impact of antibiotics on gut bacteria of children = potential loss of persistent strains (may include those from birth) .

https://neurosciencenews.com/bacterial-persistence-microbiome-18723/amp/