The Hierarchy of Evidence Flashcards
1
Q
Hierarchy of Evidence
A
2
Q
Hierarchy of Evidence
A
3
Q
Assessing risk of bias
A
4
Q
Assessing risk of bias
A
5
Q
Assessing risk of bias
- Quality appraisal tools are used
- DURING …-… process – by authors to ensure high quality …
- AFTER …-… process - by readers to … risk of bias within studies
- Quality appraisal tools take the form of a … with a list of items that, for higher quality, should be included
- Within the study itself
- Within the report
- Some tools give rise to a … score or … rating
- Risk of bias can be assessed both
- Within individual studies
- Collectively acrossstudies
A
- Quality appraisal tools are used
- DURING write-up process – by authors to ensure high quality reporting
- AFTER write-up process - by readers to review risk of bias within studies
- Quality appraisal tools take the form of a checklist with a list of items that, for higher quality, should be included
- Within the study itself
- Within the report
- Some tools give rise to a numerical score or categorical rating
- Risk of bias can be assessed both
- Within individual studies
- Collectively acrossstudies
6
Q
Assessing risk of bias
- When are quality appraisal tools used?
A
- Quality appraisal tools are used
- DURING write-up process – by authors to ensure high quality reporting
- AFTER write-up process - by readers to review risk of bias within studies
7
Q
Assessing risk of bias
- Risk of bias can be assessed both…
A
- Within individual studies
- Collectively acrossstudies
8
Q
Assessing risk of bias
- Quality appraisal tools take the form of a checklist with a list of items that, for higher quality, should be included
- Within the study itself
- Within the report
A
- Within the study itself
- Within the report
9
Q
Case reports - Hierarchy of Evidence
- Disadvantages:
- Only …
- Lack of g…
- Uncontrolled
- Uncertain … o../s
- Changing features to preserve … could impact on usefulness
- Advantages:
- Can include …-… analyses/ experiential inquiries of person/ group in …-… setting
- Utility in emerging epidemics and previously unrecognised syndromes
- Fast and …
- Good … tool
A
- Disadvantages:
- Only descriptive
- Lack of generalisability
- Uncontrolled
- Uncertain future outcome/s
- Changing features to preserve anonymity could impact on usefulness
- Advantages:
- Can include in-depth analyses/ experiential inquiries of person/ group in real-world setting
- Utility in emerging epidemics and previously unrecognised syndromes
- Fast and cheap
- Good learning tool
10
Q
Case reports - Hierarchy of Evidence
- Disadvantages:
- Only descriptive
- … of generalisability
- …
- … future outcome/s
- Changing features to preserve anonymity could impact on …
- Advantages:
- Can include in-depth analyses/ experiential inquiries of person/ group in real-world setting
- Utility in emerging … and previously … syndromes
- … and cheap
- Good learning tool
A
- Disadvantages:
- Only descriptive
- Lack of generalisability
- Uncontrolled
- Uncertain future outcome/s
- Changing features to preserve anonymity could impact on usefulness
- Advantages:
- Can include in-depth analyses/ experiential inquiries of person/ group in real-world setting
- Utility in emerging epidemics and previously unrecognised syndromes
- Fast and cheap
- Good learning tool
11
Q
Animal trials - Hierarchy of Evidence
- Disadvantages:
- Not able to … all … features and …
- Introduction e.g. of allergens, pathogens not like …-…
- … between a given animal species and humans
- Animal … and …
- Advantages:
- Possibilities considered unethical in human trials
- Ability to control potential …
- Vast commonalities in the biology of most mammals
- Human diseases often affect other animal species
- Mechanisms and treatment also commonly similar in major infectious and non-infectious diseases
A
- Disadvantages:
- Not able to mimic all human features and phenotypes
- Introduction e.g. of allergens, pathogens not like real-life
- Differences between a given animal species and humans
- Animal protection and welfare
- Advantages:
- Possibilities considered unethical in human trials
- Ability to control potential confounds
- Vast commonalities in the biology of most mammals
- Human diseases often affect other animal species
- Mechanisms and treatment also commonly similar in major infectious and non-infectious diseases
12
Q
Animal trials - Hierarchy of Evidence
- Disadvantages:
- Not able to mimic all human features and phenotypes
- Introduction e.g. of allergens, pathogens not like real-life
- … between a given animal species and humans
- Animal … and …
- Advantages:
- Possibilities considered … in human trials
- Ability to control potential confounds
- Vast … in the biology of most mammals
- Human … often affect other animal species
- Mechanisms and treatment also commonly similar in … infectious and …-infectious diseases
A
- Disadvantages:
- Not able to mimic all human features and phenotypes
- Introduction e.g. of allergens, pathogens not like real-life
- Differences between a given animal species and humans
- Animal protection and welfare
- Advantages:
- Possibilities considered unethical in human trials
- Ability to control potential confounds
- Vast commonalities in the biology of most mammals
- Human diseases often affect other animal species
- Mechanisms and treatment also commonly similar in major infectious and non-infectious diseases
13
Q
Meta-analysis/Systemic reviews - Hierarchy of Evidence
- Disadvantages:
- Limited by … and amount of available …
- Meta-analysis of different study type occupies same top pole
- Limited inclusion of/ focus on … research
- …-defined question
- Advantages:
- Summary of overall evidence area
- … policy and clinical decision-making
- Identify and test sources of variability
A
- Disadvantages:
- Limited by quality and amount of available evidence
- Meta-analysis of different study type occupies same top pole
- Limited inclusion of/ focus on qualitative research
- Narrowly-defined question
- Advantages:
- Summary of overall evidence area
- Guide policy and clinical decision-making
- Identify and test sources of variability
14
Q
Meta-analysis/Systemic reviews - Hierarchy of Evidence
- Disadvantages:
- Limited by quality and amount of available evidence
- Meta-analysis of different study type occupies same top pole
- … inclusion of/ focus on qualitative research
- …-defined question
- Advantages:
- Summary of overall evidence area
- Guide policy and … decision-making
- Identify and test sources of …
A
- Disadvantages:
- Limited by quality and amount of available evidence
- Meta-analysis of different study type occupies same top pole
- Limited inclusion of/ focus on qualitative research
- Narrowly-defined question
- Advantages:
- Summary of overall evidence area
- Guide policy and clinical decision-making
- Identify and test sources of variability
15
Q
Evidence-based medicine (EBM)
- “Evidence based medicine is the c…, e…, and judicious use of current best evidence in making decisions about the care of … patients” (David Sackett)
- “(1) that our clinical and other health care decisions should be based on the best patient- and population-based as well as ..-based evidence;
- (2) that the … determines the nature and source of evidence to be sought, rather than our habits, protocols or traditions;
- (3) that identifying the best evidence calls for the integration of e… and b… ways of thinking with those derived from pathophysiology and our personal experience;
- (4) that the conclusions of this search and critical … of evidence are worthwhile only if they are translated into actions that affect our patients;
- (5) that we should continuously evaluate our … in applying these ideas.” (Sackett & Rosenberg)
A
- “Evidence based medicine is the conscientious , explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (David Sackett)
- “(1) that our clinical and other health care decisions should be based on the best patient- and population-based as well as laboratory-based evidence;
- (2) that the problem determines the nature and source of evidence to be sought, rather than our habits, protocols or traditions;
- (3) that identifying the best evidence calls for the integration of epidemiological and biostatistical ways of thinking with those derived from pathophysiology and our personal experience;
- (4) that the conclusions of this search and critical appraisal of evidence are worthwhile only if they are translated into actions that affect our patients;
- (5) that we should continuously evaluate our performance in applying these ideas.” (Sackett & Rosenberg)
18
Q
EBM and evidence appraisal
- Evidence … is the process of deciding whether, and to what degree, evidence (either from a … study or an … base of many studies) supports a ….
A
- Evidence appraisal is the process of deciding whether, and to what degree, evidence (either from a single study or an evidence base of many studies) supports a claim.
27
Q
Allergy: The case of the cow milk protein allergy
- Non-IgE mediated cow’s milk protein allergy in breastfed infants
- Premise:
- In an …-… infant, if a mother ingests cow’s milk, the child will develop an allergy
- Either the mother needs to stop consuming dairy or the child should switch to a non-dairy formula
- 2006-2016
- NHS prescriptions for formula rose from 100,000 to over … annually
- NHS spend from …% from £8.1m to over £60m annually
- Premise:
- BUT: …..
- Guideline endorsement; NICE 2011, Milk Allergy in Primary (MAP) Care guideline 2013, International iMAP guidelines 2017
A
- Non-IgE mediated cow’s milk protein allergy in breastfed infants
- Premise:
- In an exclusively-breastfed infant, if a mother ingests cow’s milk, the child will develop an allergy
- Either the mother needs to stop consuming dairy or the child should switch to a non-dairy formula
- 2006-2016
- NHS prescriptions for formula rose from 100,000 to over 600,000 annually
- NHS spend from 700% from £8.1m to over £60m annually
- Guideline endorsement; NICE 2011, Milk Allergy in Primary (MAP) Care guideline 2013, International iMAP guidelines 2017
- BUT!! see slide attached
- Premise:
34
Q
Nonetheless… (hierarchy of evidence importance)
A
