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Module 3 Finding the Evidence: Pre-appraised Literature

Module 3 Finding the Evidence: Pre-appraised Literature. EBM Literature: Reviews. Individual Studies: Experimental. Individual Studies: Observational. Evidence hierarchy. Meta a nalyses Systematic reviews. Randomized control trials (RCTs) Controlled trials w/o randomization.

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Module 3 Finding the Evidence: Pre-appraised Literature

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  1. Module 3Finding the Evidence:Pre-appraised Literature

  2. EBM Literature: Reviews Individual Studies:Experimental Individual Studies:Observational Evidence hierarchy Meta analyses Systematic reviews Randomized control trials (RCTs) Controlled trials w/o randomization Level of evidence Cohort studies Case control studies/retrospective cohort Case studies/qualitative studies

  3. Review literature Systematic reviews • Address a single clinical question • Locate and validate all trials/studies relevant to the question (inclusion and exclusion criteria) • Should include an explicit literature search • Draw a conclusion, if possible, based on multiple studies Meta-analyses • Systematic reviews taken 1 step further • Look for studies where the data can be combined large study • End product is often displayed in a graphical format (forest plot)

  4. Growth of reviews 15,000 12,500 10,000 7500 # published per year 5000 2500 1990 1995 2000 2005 2010

  5. Finding worthy reviews

  6. DARE DARE (CRD) commentary for:Gaster B, Holroyd J. St John's Wort for depression: a systematic review. Archives of Internal Medicine 2000; 160(2): 152-156

  7. Finding worthy reviews

  8. ACP Journal Club

  9. Finding worthy reviews

  10. Clinical Evidence

  11. Finding any reviews

  12. Appraising reviews

  13. An example Linde K, et al. 2005. St John's wort for depression: meta-analysis of randomised controlled trials. British Journal of Psychiatry 186:99-107

  14. Still many interventions not covered by SRs The Cochrane Database is good example of this: approximately 10-15,000 Cochrane reviews are needed to cover interventions that have been investigated in clinical trials. After 18 years <50% have been published (completion is est. ~30 years). Need constant upkeep Half will need to be updated each year Most take 6-12 months to be developed and published Keep in mind

  15. Module 3Finding the Evidence:Pre-appraised Literature

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