Getting to the bottom of evidence based medicine

doi:10.1136/bmj.39486.615741.AD

BMJ 2008;336:764 (5 April), doi:10.1136/bmj.39486.615741.AD

Filler

Getting to the bottom of evidence based medicine

Susan Bewley, consultant obstetrician

¹ Guys and St Thomas’ Foundation Trust, London

susan.bewley@gstt.nhs.uk

The first 150 words of the full text of this article appear below.

"Which way up should I put the suppository?" I’ve askedthis question of countless junior obstetricians over the yearsas we administer rectal analgesia after a caesarean section.¹Despite thinking it might be a trick question, they all wantto insert the pointed end of the bullet shaped object first.²Surely that’s how they are designed, and it would be morecomfortable?

Well, no. It was Minerva herself who drew this to my attention:a trial confirms that blunt end first is preferable.³ Possiblybecause of the tapered shape and tone of the sphincter, fingersrarely need to be inserted into the anal canal (1% v 83%) asthe suppository is "sucked" up and fewer suppositories are expelled(0 v 3%). There is 82% less invasive administration, and drugdelivery and costs should improve by 3%. So, here is a simple,easy improvement to your practice. Or is it? At . . . [Full text of this article]

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Rapid Responses:

Read all Rapid Responses

Re-shaping suppositories: Stephen H Raymond
bmj.com, 5 Apr 2008 [Full text]
But are double points the bottom line?: Anthony EJ Fitchett
bmj.com, 8 Apr 2008 [Full text]