ICM - Research

Question 1

What is evidence-based medicine?

Answer 1

The integration of:
- best research evidence,
- clinical expertise
- and patient values.

Question 2

How can the quality of clinical evidence be assessed?

Answer 2

1. Hierarchy of study types - Meta-analysis, RCT, non-randomised interventions, observational studies.
2. SIGN grading of recommendations. Scottish Intercollegiate Guidelines Network (SIGN) grades levels of evidence using both digits and + or -. 1++ is the highest quality of evidence through 1+, 1-, then 2++, 2+ and 2-, 3 and 4.
3. GRADE methodology - GRADE scores A high, B moderate, C low or D very low. It forms the basis of the English NICE and Scottish SIGN systems of evaluation.

Question 3

What is the GRADE methodology?

Answer 3

Grades of Recommendation, Assessment, Development and Evaluation
Recommends
:i) The quality of the evidence is the extent to which the estimate of effect is correct.
ii) The strength of a recommendation is the extent of confidence with which adherence to a recommendation will do more harm than good.

Question 4

What determines the strength of a recommendation in GRADE methodology?

Answer 4

Grading of Recommendations, Assessment, Development, and Evaluations

1. Quality of evidence: High, mod, low,very low
2. Trade-offs: Likelihood of benefit over harm
3. Applicability: Right patient group and circumstances
4. Baseline risk confidence

Overall strength of recommendation outcome:
- do it
- don’t do it
- probably do it
- probably don’t do it
- unable to make a recommendation