(Hurwtiz et al, JBJS , 2000) Common Problem Uncommon Problem Patient-Oriented Evidence Best Best source of POEMs Relevance: I Only if Time May not be relevant to everyday practice Relevance: II Disease-Oriented Evidence Danger Can be misleading Relevance: III Worst Read only if extremely interested Relevance: IV
A 46 year old male had been moving rocks for his rock garden when he felt a twinge and his low back became excruciatingly painful. He's come into the ER and is extremely unhappy and demanding an MRI. You thought CT was the standard for diagnosis. P : patient with acute low back pain I : MRI C : CT Scan O : Diagnostic effectiveness Answerable Question : in patients with low back pain, is MRI more effective than CT scanning for diagnostic purposes?
Anecdotal Animal / Bench research Unpublished clinical observations Case series Poorly designed cohort / case-control Case-control Cohort Well-designed RCTs / prospective studies Level 5 Level 4 Level 3 3a: SR of case-control studies 3b: Individual case-control Level 2 2a: SR of cohort studies 2b: Individual cohort studies 2c: Outcomes research Level 1 1a: SR of RCTs 1b: Individual RCTs 1c: All or none studies
Annotation Clinical Relevance Clinical Question LOE Analysis “ Bottom Line” Patient Education Critical Appraisal AT 5070 AT 5120 AT 5220
http://clinques.nlm.nih.gov/JitSearch. html The ClinicalQuestions Collection is a growing repository of questions that have been collected from healthcare providers in clinical settings across the country. The questions have been submitted by investigators who wish to share their data with other researchers. http ://www.cebm.utoronto.ca / Main CEBM site http ://www.pedro.fhs.usyd.edu.au/scale_item. html PEDro http ://ebmlibrarian.wetpaint.com / EBM Librarian - has info on appraisals and CATS http://www.cche.net/usersguides/ebm.aspHas info on the Users' Guides http ://pubs.ama-assn.org/misc/usersguides. dtl Users' Guides http ://www.ebmny.org/cats. html CATS http ://www.otcats.com / OT CATS