Transcript Evidence Based Medicine Journal Article Review

Evidence-Based Medicine
Presentation
[Insert your name here]
[Insert your designation here]
[Insert your institutional affiliation here]
Department of Obstetrics & Gynecology
Greenville Hospital System University Medical Center
Greenville, South Carolina
Patient Presentation
• Details of patient presentation that prompted
the clinical question
Clinical Question
• State the clinical question
Background
• What general knowledge about the clinical topic
and or disease is needed PRIOR to searching for
evidence to answer your specific clinical
question?
• Limit background slides to 2 slides at most
Search Strategy
• List the data sources you utilized
• If you conducted a search of an electronic
database, summarize your search strategy
Search Results
• For each data source, list the types of
information that you identified
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RCT
Case-control studies
Cohort studies
Case series
Guidelines, expert opinions, review articles
Evidence Appraisal
• List which of the identified sources were
appropriate to your specific clinical question
• Summarize how you determined which of the
identified studies were appropriate to use in
answering your specific clinical question
• Remember, you are not trying to present ALL
of the evidence, just the BEST evidence
Evidence Appraisal
• For each BEST evidence source, perform a
critical appraisal, to include some or all of the
subsequent slide content
• You must critically evaluate EACH evidence
source that you believe helps to answer your
clinical question.
Hypothesis
• If an analytic study, what is the hypothesis that
is being tested?
Objectives
• What are the primary and secondary objectives
of the study?
Methods: Design
• What type of study was done?
 Primary research (experiment, randomized
controlled trial, other controlled clinical trial, cohort
study, case control study, cross sectional survey,
longitudinal survey, case report, or case series)?
 Secondary research (simple overview, systematic
review, meta-analysis, decision analysis, guideline
development, economic analysis)?
• If a “randomized trial” was randomization truly
random?
Methods: Setting
• What is the setting in which the subjects were
studied (e.g. inpatient, outpatient, community
hospital, teaching hospital, university)?
• If a clinical investigation, was the study
conducted in “real life” circumstances?
Methods: Subjects
• Who is the study about?
 How were subjects recruited?
 Who was included in and who was excluded from
the study?
Methods: Interventions
• What intervention or other maneuver was being
considered?
Methods: Outcomes
 What outcome(s) were measured and how?
• Was assessment of outcome (or, in a casecontrol study, allocation of cases) “blind”?
 Was follow-up complete?
Methods: Statistics
• What sort of data do the authors have?
• What types of statistical tests were used and
were they appropriate to the data type?
• Have the data been analyzed according to the
original study protocol?
Results
• Were the groups similar at the start of the trial?
• Aside from the experimental intervention, were
the groups treated equally?
• What are the key results?
Conclusions
• Do the results support the original study
hypothesis?
Commentary
• Does the evidence you found help to answer
your original clinical question?
– Can the results be applied to my patient case?
– Will the results lead directly to selecting or avoiding
therapy?
– Are the results useful for reassuring or counseling
patients?
Recommendation
• State what specific recommendation that you can make (if any)
in regards to your clinical question and list the level of evidence
for each recommendation:
– Level I: Evidence obtained from at least one properly designed RCT
– Level II-1: Evidence obtained from well-designed controlled trials
without randomization
– Level II-2: Evidence obtained from well-designed cohort or case-control
studies analytic studies
– Level II-3: Evidence obtained from multiple time series, with or without
the intervention
– Level III: Opinions of respected authorities, based on clinical experience,
descriptive studies, or reports of expert committees
References