The document provides an overview of critical appraisal of medical research. It discusses study designs such as randomized controlled trials, observational studies, systematic reviews and meta-analyses. It also covers topics like developing PICO(T) questions to frame clinical questions, different types of study questions, evaluating studies using the FRISBE mnemonic, calculating measures of clinical importance, and resources for evidence-based practice.
Critical appraisal is the process of carefully and systematically analyze the research paper to judge its trustworthiness, its value and relevance in a particular context. (Amanda Burls 2009)
A critical review must identify the strengths and limitations in a research paper and this should be carried out in a systematic manner.
The Critical Appraisal helps in developing the necessary skills to make sense of scientific evidence, based on validity, results and relevance.
Research requires properly planned methodology. I would like to recommend that researchers to focus on these 4 critical steps. If these steps are fulfilled, you will find it easy to conduct your research.
This is a lecture I wrote to introduce my students to the concept of Evidence Based medicine. Goes hand in hand with many handouts, such as the parachute study.
Special thanks to Dr. Brian Bledsoes lecture on EBM, from wich I pirated liberally.
Microservices Standardization - Susan Fowler, StripeAmbassador Labs
Susan Fowler of Stripe and Uber and Author of Production-Ready Microservices (O'Reilly) presents about how to standardize your microservices to make them production ready at the 2017 Microservices.com Practitioner Summit.
Critical appraisal is the process of carefully and systematically analyze the research paper to judge its trustworthiness, its value and relevance in a particular context. (Amanda Burls 2009)
A critical review must identify the strengths and limitations in a research paper and this should be carried out in a systematic manner.
The Critical Appraisal helps in developing the necessary skills to make sense of scientific evidence, based on validity, results and relevance.
Research requires properly planned methodology. I would like to recommend that researchers to focus on these 4 critical steps. If these steps are fulfilled, you will find it easy to conduct your research.
This is a lecture I wrote to introduce my students to the concept of Evidence Based medicine. Goes hand in hand with many handouts, such as the parachute study.
Special thanks to Dr. Brian Bledsoes lecture on EBM, from wich I pirated liberally.
Microservices Standardization - Susan Fowler, StripeAmbassador Labs
Susan Fowler of Stripe and Uber and Author of Production-Ready Microservices (O'Reilly) presents about how to standardize your microservices to make them production ready at the 2017 Microservices.com Practitioner Summit.
The 2012 season is lagging behind past seasons: By Sept. 5, 2005, we had three major hurricanes (Dennis, Emily, and Katrina),and by Sept. 5, 2011, we had one major hurricane (Katia). This year, we have one-- Michael. Powerpoint courtesy of Dr Walter Hays, Global Alliance for Disaster Reduction
Assessments indicate that the new needs arising from Sandy will require US$139.9 million in additional funding over 2012 and 2013. Of this, $23.2 million will be required to finance the first phase of the response until the end of the year, which is outlined in this Emergency Revision of the 2012 CAP. This first phase will immediately address the critical needs of 1.26 million people in food security and nutrition, shelter, health, WASH, and education. This brings the 2012 CAP's overall revised requirements to $151,080,810, and leaving unmet requirements of $95,344,094.
Epidemiology, as the applied instrument of public health interventions, can provide much needed information on which a rational, effective, and ?exible policy for the management of disasters can be based. In particular, epidemiology provides the tools for rapid and effective problem solving during public health emergencies, such as natural and technologic disasters and emergencies from terrorism.
The most destructive tornado outbreak of 2014 killed at least 18 people in three states and hammered the suburbs of Little Rock, Arkansas over a 200-mile-long path. In all, at least 31 tornadoes were recorded. They formed late in the day, and were especially destructive in Arkansas because they struck as night fell. The peak tornado season is late winter through midsummer. But tornadoes can happen any time of the year when the atmospheric conditions are right. Lessons learned from tornadoes. Timely communication of critical inform-ation in the form of watches and warnings is essential for safety. Presentation courtesy of Dr. Walter Hays, Global Alliance for Disaster Reduction
Mitigation and adaptation strategies for coping with the potential adverse effects of global climate change. If the predictions are right, we will be living with the effects of global climate change for the rest of our lives. Many countries are now making large investments in mitigation and anticipatory adaptation actions. Leaders recogniize that the effects of global climate change will likely increase the risks for people, businesses, and communities living in or located in coastal areas or in river floodplains. Presentation courtesy of Dr Walter Hays, Global Alliance for Disaster Reduction
The following presentation I gave last week at an industry association event held at London's Law Society.
Measuring Social Media, tracking, operandi partners, rob gallo, social media, PR, corporate comms
Sandy, 2012’s ninth hurricane, became a huge storm with wind and rain bands reaching out 500 km or more from the storm center, produced 15-50 cm of rain and flooding in Jamaica, Bermuda, Haiti, Dominican Republic, Cuba, New Jersey, and New York
Comparing research designs fw 2013 handout versionPat Barlow
This is an updated version of my Comparing Research Designs lecture, which now includes discussions on: (1) common considerations with research design such as bias, reliability, validity, and confounding; and (2) expanded discussion of RCT designs including factorial and cross-over designs.
This is the handout version of a lecture I give to medical residents and fellows on the basics of clinical research designs and the inherent issues that go along with each one. I give this lecture as part of a multi-module lecture series on research design and statistical analysis.
How to scientifically conduct a clinical professional research trial? In the current era of Collaborate or parish, we need to keep this design in our mind.
Enjoy
@copyLeft
1. Critical Appraisal
of Medical Research
Susan Fowler, MLIS
314-362-8092
fowler@wustl.edu
Photo: http://www.pantherkut.com/2009/05/27/cat-thoughts/
2. Agenda
• Study Design
• PICO(T)
• Types of Questions
• FRISBE
• Clinical Importance
• 3 Therapy
Examples
• Resources
Photo: http://catscientists.tumblr.com/post/19458666129
Susan Fowler, MLIS Washington University in St. Louis
5. Study Designs Defined
meta-analysis: a quantitative approach in which individual study findings addressing a
common problem are statistically integrated and analyzed to determine the
effectiveness of interventions.
systematic review: a process by which a body of literature is reviewed and assessed
using systematic methods which are intended to reduce bias in the review process
and improve understandability. A controlled clinical trial in which the study groups
are created through randomization.
randomized controlled trial: an experiment in which investigators randomly allocate
participants into (eg treatment and control) groups to receive or not to receive one
or more interventions that are being compared.
controlled clinical trial: any study which compares two groups by virtue of different
therapies or exposures.
cohort study: an observational study in which a cohort is followed over time.
case-control studies: retrospective research design that compares individuals with a
specific condition to those without it.
case report: a detailed report of the symptoms, signs, diagnosis, treatment, and
follow-up of an individual patient.
case series: a report on a series of patients with an outcome or condition of interest.
Susan Fowler, MLIS Washington University in St. Louis
2012
6. PICO (T)
• Patient or problem - How would I describe a group of
patients similar to mine?
• Intervention - Which main intervention, prognostic
factor, or exposure am I considering?
• Comparison (if appropriate)- What is the main
alternative to compare with the intervention?
• Outcome - What can I hope to accomplish, measure,
improve or affect?
• Type of Study – Based on my question, what type of
study will provide the best answer?
Susan Fowler, MLIS Washington University in St. Louis
2012
7. Types of Questions
Type of Question Ideal Type of Study
Therapy RCT
Prevention RCT > Cohort > Case Control
Diagnosis Prospective, blind controlled
comparison to gold standard
Prognosis Cohort > Case Control > Case
Series/Case Report
Etiology/Harm RCT > Cohort > Case Control
Susan Fowler, MLIS Washington University in St. Louis
2012
8. *FRISBE
•Follow Up
•Randomization
•Intention to Treat
•Similar Baseline
•Blinding
•Equal Treatment
*Mnemonic tool created by Connie Schardt, AHIP
Susan Fowler, MLIS Washington University in St. Louis
2012
9. Follow Up – Were all patients who entered the trial
properly accounted for and attributed at its
conclusion?
Randomization - Was the allocation (assignment) of
patients to treatment randomized?
Was the allocation concealed?
Intention-to-Treat Analysis - Were patients analyzed
in the groups to which they were
randomized? Were all randomized patient
data analyzed?
Similar Baseline Characteristics of Patients - Were
groups similar at the start of the trial?
Blinding - Were patients, health workers, and study
personnel "blind" to treatment?
Equal Treatment - Aside from the experimental
intervention, were the groups
treated equally?
Photo: http://www.glassofwin.com/2010/06/03/cats-of-win-three-years/
Susan Fowler, MLIS Washington University in St. Louis
11. EER (Experimental Event Rate): The proportion of patients in the experimental
treatment group who are observed to experience the outcome of interest.
CER (Control Event Rate): The proportion of patients in the control group
observed to experience the outcome of interest.
ARR (Absolute Risk Reduction): The absolute arithmetic difference in rates of bad
outcomes between experimental and control participants in a trial. (Also referred to
as risk difference).
RRR (Relative Risk Reduction): The proportional reduction in rates of bad
outcomes between experimental and control participants in a trial.
NNT (Number Needed to Treat): The number of patients who need to be treated
with the specified intervention to prevent one bad outcome or to produce one good
outcome over the period of time specified in the study.
Susan Fowler, MLIS Washington University in St. Louis
2012
12. Outcome Outcome
Present Absent
Treated a= b= EER
Exposed a
a+b
Control/not c= d= CER
exposed c
c+d
RRR ARR NNT
CER EER (CER-EER) CER-EER 1
CER ARR
Susan Fowler, MLIS Washington University in St. Louis
2012
15. Library Resources
Evidence at Becker (How To):
http://beckerguides.wustl.edu/ebm
Duke University Evidence-Based
Practice:
http://guides.mclibrary.duke.edu/eb
m
Centre for Evidence Based
Medicine:
http://www.cebm.net/index.aspx?
o=1023
Susan Fowler, MLIS
fowler@wustl.edu
314-362-8092
Clip Art from http://www.wpclipart.com/
Susan Fowler, MLIS Washington University in St. Louis
16. Q
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s
t
I
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s
Photo by Juniors Bildarchiv
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Susan Fowler, MLIS Washington University in St. Louis
2012