1 / 29

Evidence Based Medicine Introduction to Critical Appraisal

Evidence Based Medicine Introduction to Critical Appraisal. Jeffrey P Schaefer MSc MD FRCP FACP October 21, 2010. Objectives. You will: define evidence based medicine know where critical appraisal fits into EBM list 5 important clinical questions describe best research designs

bond
Download Presentation

Evidence Based Medicine Introduction to Critical Appraisal

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Evidence Based MedicineIntroduction to Critical Appraisal Jeffrey P Schaefer MSc MD FRCP FACP October 21, 2010

  2. Objectives • You will: • define evidence based medicine • know where critical appraisal fits into EBM • list 5 important clinical questions • describe best research designs • know the basic approach to critical appraisal • be exposed to CA for each clinical question

  3. What is Evidence Based Medicine?

  4. What is Evidence Based Medicine • Application of the best evidence to health problems within the context of the expertise and values of the patient, physician, and society. • JP Schaefer

  5. EBM Process • Formulate a focused clinical question. • Search for evidence. • Critically appraise the evidence. • Apply the evidence to your practice. • Learnings are stored for future reference. • Outcomes are reviewed.

  6. The Essence of Critical Appraisal • Three Questions • Are the results valid? • What are the results? • Do the results apply to my patient?

  7. What Critical Appraisal is Not... • It’s not about trashing an article • something can be learned from every article, even if it’s how to design a better trial! • It’s not about black and white answers • most studies have strengths and weaknesses • some studies are highly edited • It’s not the only reason to embark on a course of action • other factors (harm, cost, patient values)

  8. Five Clinical Questions • Harm • Diagnosis • Therapy • Prognosis • Prevention • Also… • systematic reviews (e.g. meta-analyses) • econominc analyses • others

  9. SENS 41 / 48 = 0.854 = 85% SPEC 346 / 357 = 0.969 = 97% PPV 41 / 52 = 0.788 = 79% NPN 346 / 353 = 0.980 = 98% http://faculty.vassar.edu/lowry/clin1.html

  10. Not sure: issue here is the false negatives.

  11. General Issues • multiple strange questions in same article • why differentiate lipoma from IM lipoma? • how did 600 cases get to 405 cases? • why exclude ‘rare forms’? • how did molecular studies get to be gold-std? • initial surgical tx was / is independent of pathology • failure to provide CI for test characteristics • accuracy is not very useful

More Related