4 - Finding the Evidence

Question 1

PICO

Answer 1

Patient
Intervention
Comparison
Outcome

Question 2

Resources for Finding the Evidence

Answer 2

Cochrane Library
MEDLINE
EBM

Question 3

What’s the best?

Answer 3

A Randomized Control Trial (RCT) with a meta-analysis

Question 4

What criteria do we use to appraise evidence?

Answer 4

Quality of studies
Deisgn-specific checklists
(meta-analysis, RCT, studies of diagnostic tests, observational studies

Question 5

How do we apply the evidence?

Answer 5

Make diagnostic and treatment decisions

Question 6

How do we evaluate performance?

Answer 6

Assess outcomes at patient and population levels

Question 7

Hierarchy of Evidence

Answer 7

Systematic review of RCTs with or without meta-analysis
RCTs
Cohort Studies
Case-Control Studies
Case Series
Case Reports
Opinion

Question 8

How do we find RCTs?

Answer 8

Medline
Cochrane Registry of Clinical Trials
Clinicaltrials.gov
Database of Abstracts of Reviews of Effects (DARE) from the Centre for Reviews and DIssemination (UK)
Agency for Healthcare Research and Quality (AHRQ)
Evidence Updates from BMJ Evidence Centre
National Guidelines Clearinghouse from the US DOH & Human Services - Clinical Practice Guidelines
NHS Evidence from the UK National Institute for Health and Clinical Excellence (NICE)

Question 9

Assessing the Study

Answer 9

Does the study question match your question?
Was the study design appropriate?
Were the recruited patients representative of the target population?
Was the allocation of patients to treatment randomized and concealed?
Were patients, health workers, and study personnel “blind” to treatment?
Aside form the experimental intervention, were the groups treated equally?