Peter Trewby

The SIBDQ: further validation in ulcerative colitis patients

OBJECTIVE:The Inflammatory Bowel Disease Questionnaire (IBDQ) is an instrument that assesses quality of life in patients with inflammatory bowel disease. It has 32 items in four domains. The short form of the IBDQ (SIBDQ) was developed in Canadian Crohns disease patients for use in clinical practice. Patients with ulcerative colitis might require a different form of the SIBDQ. Our aim was to design and validate a SIBDQ for patients with ulcerative colitis and to compare this to the Crohns SIBDQ.METHODS:We recruited 122 patients with colitis as an initial sample. Using linear regression modeling, the 10 items that best predicted the total IBDQ score were identified. The colitis and Crohns versions of the SIBDQ were compared by univariate linear regression with the total IBDQ score in two other cohorts of colitis patients.RESULTS:Ten items explained 97% of the variance of the total IBDQ score in our first cohort. These were items 1 and 9 (bowel); 7, 11, 21, 30 (emotional); 2 and 10 (systemic); and 12 and 28 (social). Only three items were shared with the Crohns SIBDQ. The R2 for both SIBDQs with the total IBDQ score in the other cohorts were very high (≥0.95), although the Colitis SIBDQ showed better internal consistency.CONCLUSIONS:The development of a SIBDQ for patients with ulcerative colitis did not reveal any clear advantage over the original version of the SIBDQ. Further studies are required to determine the role of the SIBDQ in routine clinical practice.

“Polypill” to fight cardiovascular disease: Patients before populations

EDITOR—Wald and Laws provocative paper and the accompanying editorial on the “Polypill” was disappointing in focusing only on the advantage to the population and ignoring the individuals views of the benefit he or she would wish to see from taking preventive drugs.1 2 The median threshold of absolute risk reduction below which patients would not wish to take a preventive drug may be as high as 30% over five years. This …

Number needed to sacrifice: statistical taboo or decision-making tool?

The percentage that benefit from medical preventive measures is small but all are exposed to the risk of side effects so most of those harmed would never benefit from their use. There is no expression or acronym to describe the ratio of harm to benefit nor discussion of what level of harm is acceptable for what benefit. Here we describe the harm to benefit ratio (HBR) expressed as number harmed (H) for 100 to benefit (B) and calculated for commonly used medical interventions. For post TIA carotid endarterectomy the HBR is 25 (25 postoperative strokes or deaths are caused for 100 to be stroke free at 5 years); warfarin in atrial fibrillation in patients aged under 65 results in 400 intracerebral haemorrhages for every 100 saved from a thromboembolic event; fibrinolytic treatment for stroke causes 44 symptomatic intracranial haemorrhages for every 100 that have minimal disability at 3 months; aspirin in high risk patients causes 33 major bleeds for every 100 occlusive vascular events prevented; routine inpatient thromboprophylaxis causes 133 additional bleeds for every 100 pulmonary emboli prevented; breast cancer screening causes 1000 unnecessary cancer treatments for 100 cancer deaths to be prevented. Conclusion: The HBR or number needed to sacrifice is larger than most imagine. Its wider use would allow us better to recognise the number harmed, allow better informed consent, compare different preventive strategies and understand the risks as well as benefits of preventive treatments.

Alan Scott Falconer

Alan Scott Falconer was born in Darlington, the son of a GP-surgeon. His medical training was at Peterhouse College, Cambridge, and St George’s Hospital, London. He undertook house officer posts at St George’s, followed by national service in the Royal Navy. After obtaining his FRCS and surgical training at …

Dare to tell

I commend an alternative, but perhaps more patient centred, interpretation of the Cochrane hierarchy of evidence described by Jarvinen and colleagues.1 The first rungs on the ladder—“Can it work?” and “Does it work?”—are answered by the science underlying the intervention and the controlled trial. But the third rung—“Is it worth it?”—should not be asked first of health economists …

The cry of a trapped heart

We present a case referred for endoscopy because of symptoms of dyspepsia and abnormal liver function tests. These more obvious symptoms masked an underlying history of shortness of breath on exertion and mild bipedal oedema. Physical examination revealed a raised jugular venous pulse with pulsus parodoxus, hepatomegaly, mild ascites and slight bipedal oedema. Investigations confirmed the presence of idiopathic calcific constrictive pericarditis. An early surgical pericardiectomy led to resolution of symptoms and signs, and a normalisation of liver biochemistry.

Foundations of Evidence-Based Medicine

‘As soon as he got home, he went to the larder; and he stood on a chair, and took down a very large jar of honey. It had HUNNY written on it, but, to make sure, he took off the paper cover and looked at it, and it looked just like honey. ‘‘But you never can tell’’, said Pooh. So he put his tongue in it and took a large lick. ‘‘Yes’’ he said, ‘‘it is. No doubt about that. And honey I should say, right down to the bottom of the jar. Unless, of course,’’ he said, ‘‘someone put cheese in at the bottom just for a joke. Perhaps I had better go a little further just in case. . . . Ah!’’ And he gave a deep sigh. ‘‘I was right, it is honey, right the way down.’’ ’