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Module 6 Making a Case. Table of Evidence. Study types. Lit search?. Results consistent?. Valid?. Review. # studies/part. Outcome. Linde, 2005. 26/3320. RCTs. Yes. Yes. Yes. Moderate improvements for mild or temp depression ONLY. Whiskey, 2001. 14/1296. RCTs. Yes. No. Yes.
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Table of Evidence Study types Litsearch? Results consistent? Valid? Review # studies/part Outcome Linde, 2005 26/3320 RCTs Yes Yes Yes Moderate improvements for mild or temp depression ONLY Whiskey, 2001 14/1296 RCTs Yes No Yes Moderate improvements for mild or temp depression ONLY
Table of Evidence Study Intervention Duration Study Type Sample Outcome Casper, 2006 600mg/daily 6-week RCT n= 205 Mean score (HMD) 123 I decreases: 82 C 11.6 for SJW 6.0 for placebo
SORT A – Recommendation based on consistent and good quality (level 1 study quality) patient-oriented evidence Study Quality Diagnosis Scenarios Therapy/Prevention Scenarios Harm/Etiology Scenarios
SORT A – Recommendation based on consistent and good quality (level 1 study quality) patient-oriented evidence B – Recommendation based on inconsistent and limited quality (level 2 study quality) patient-oriented evidence Study Quality Diagnosis Scenarios Therapy/Prevention Scenarios Harm/Etiology Scenarios
SORT A – Recommendation based on consistent and good quality (level 1 study quality) patient-oriented evidence B – Recommendation based on inconsistent and limited quality (level 2 study quality) patient-oriented evidence C – Recommendation based on consensus, usual practice, opinion (level 3) study quality) disease-oriented evidence Study Quality All Scenarios
SORT Patient-oriented evidencemeasures outcomes that matter to patients: morbidity, mortality, symptom improvement, cost reduction, and quality of life.Disease-oriented evidencemeasures intermediate, physiologic, or surrogate end points that may or may not reflect improvements in patient outcomes (e.g., cholesterol levels, blood chemistry, physiologic function, pathologic findings).
SORT Ebell MH, et al. 2004. Strength of Recommendation Taxonomy (SORT): A Patient-Centered Approach to Grading Evidence in the Medical Literature. American Family Physician 69(3):548-556.
Three simple steps Form a clinical question (PICO, search query) Find evidence (research) Make a case