PICO or PICOTT –How to ask the questionP – Population, patient, or patient problemI – Intervention, treatment, or exposureC – Comparison of a 2nd intervention,treatment, exposureO – OutcomeTT – What type of question do I have, whattype of study do I need?
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Study Types•Etiology – Causes of a health issue•Diagnosis – Identification of a health issue•Therapy - Treatment of a health issue•Prognosis – Probability of recovery
Mining the Article DatabasesWith a well-formed PICOTT question, now you are ready to start searching for and collecting groups of results
Evidence Hierarchy•Systematic review • extensive literature search•Randomized, controlled clinical trials •randomly assigns exposure and moves forward; harder to setup/manage – ethical issues•Cohort study • large population and follow forward from exposure time
Evidence Hierarchy•Case controlled study •retrospective comparison of exposures of patients with control group; patients have the outcome and have to reflect/remember back•Case report •reports of treatment of individual patient(s) without control groups
Evaluating the Quality of Individual ArticlesWith a smaller list of key articles, now youneed to use a fine tooth comb to evaluate if the article results are reliable and applicable to your patient
FRISBE –How to Check for Quality F – Follow-up Does the study begin and end with the same number of participants? If not, do the authors acknowledge why there is a change? These factors may skew stats R – Randomization/concealed allocation Did everyone in the study have an equal chance of getting into the control or the test group? The randomization process should be concealed from researchers to avoid any bias
FRISBE –How to Check for Quality• I – Intention to treat • Although some patients may refuse or be noncompliant with treatment (real or placebo), you still need to count them in the results and note the intention• S – Similar at baseline • Patients should be similar so you don’t compare very different populations (imagine athletes vs morbidly obese people testing a diet pill)
FRISBE –How to Check for Quality• B – Blinding • In the healthcare setting, the health care providers must be blinded from knowing who is getting the test and who is getting the placebo to avoid bias• E – Equal treatment • Treatments (other than the test) should be the same across groups, otherwise you can’t determine if that specific intervention did or didn’t work or if other factors affected the results
Questions for SystematicReviews/Meta-AnalysisWas the question focused?Was a thorough review of the literature(including grey literature) completed?Do they have clear validity criteria?Are the assessments reproducible?
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