Evidence based medicine

Question 1

Which approach categories evidence high, moderate, low or very low

Answer 1

GRADE

Question 2

Traditional heirarchy approach:

Answer 2

1 Systematic reviews and meta-analyses of RCTs with definitive results
2 RCTs with definitive results (confidence intervals that do not overlap the threshold clinically significant effect)
3 RCTs with non-definitive results (a point estimate that suggests a clinically significant effect but with confidence intervals overlapping the threshold for this effect)
4 Cohort studies
5 Case-control studies
6 Cross sectional surveys
7 Case reports

Basically systematic reviews at the top, RCTs, then Co-Ca-Cro-Cas
coca (cola) crocus

Question 3

How are types of evidence graded?

Answer 3

Randomised trial = high
Observational study = low
Any other evidence = very low

Question 4

Why might a grade be reduced?

Answer 4

Serious (- 1) or very serious (- 2) limitation to study quality
Important inconsistency (- 1)
Some (- 1) or major (- 2) uncertainty about directness
Imprecise or sparse data (- 1)
High probability of reporting bias (- 1)

Question 5

And why may a grade be increased?

Answer 5

Strong evidence of association significant relative risk of > 2 (< 0.5) based on consistent evidence from two or more observational studies, with no plausible confounders (+1)
Very strong evidence of association significant relative risk of > 5 (< 0.2) based on direct evidence with no major threats to validity (+2)
Evidence of a dose response gradient (+1)
All plausible confounders would have reduced the effect (+1)

Question 6

PICO model used in evidence based medicine is designed to assist what?

Answer 6

answering/formulating a question

Question 7

What logic refers to the logical relationships among search terms

Answer 7

Boolean

Question 8

Examples of primary evidence?

Answer 8

RCTs, cohort studies, case-control studies, case-series, and conference papers

Question 9

Collection of 6 data bases

Answer 9

Cochrane library

Question 9

Examples of secondary evidence

Answer 9

evidenced based guidelines and textbooks, meta-analysis and systematic reviews

Question 10

produced by the American Psychological Association.

Answer 10

Psych info

Question 11

dedicated to providing full text articles of systematic reviews of the effects of healthcare interventions?

Answer 11

CDSR

Question 12

What is dedicated to literature produced by organisations outside of the traditional commercial or academic publishing and distribution channels

Answer 12

OpenGray

Question 13

Tips for when performing lit review

Answer 13

Include grey literature
Consider both primary and secondary sources of evidence
Use more than one database

Question 14

Is the Database of Abstracts of Reviews of Effect (DARE) filtered?

Answer 14

yes