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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

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Evidence Based Medicine Introduction to Critical Appraisal

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  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

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