This document discusses the importance of keeping up to date with medical literature for physicians. It notes that over 10,000 new articles are published per week, making it impossible for doctors to read everything. The document then provides guidance on critically evaluating medical literature, including understanding study designs and assessing validity, results, and applicability. It emphasizes applying a systematic approach to identify relevant information and avoid bias. Specific guidance is provided on appraising different study types, such as randomized trials, diagnostic tests, systematic reviews, cohort studies, and case-control studies.
EBM Is the ability to access, asses and apply the best evidence from systematic research information to daily clinical problems after integrating them with the physician's experience and patient's value.
ASSESSMENT OF BIOMEDICAL LITERATURE
Components of internal and external validity of controlled clinical trials
Internal validity — extent to which systematic error (bias) is minimized in clinical trials
Selection bias: biased allocation to comparison groups
Performance bias: unequal provision of care apart from treatment under evaluation
Detection bias: biased assessment of outcome
Attrition bias: biased occurrence and handling of deviations from protocol and loss to follow up
Requirements, needs
Planning, direction
Information collection
Information Assessment
- Evaluation for accuracy, correctness, relevance, usefulness
- Source reliability assessment (competency and past behavior based)
- Bias assessment (motivators, interests, funding, objectives)
- Conflicts of interest
- Sources of funding, important business relationships
- Grading of individual items (study, report, analysis, article)
Collation of information
- Exclusion of irrelevant, incorrect, and useless information
-Arrangement of information in a form which enables real-time analysis
- System for rapid retrieval of information
External validity — extent to which results of trials provide a correct basis for generalization to other circumstances
Patients: age, sex, severity of disease and risk factors, comorbidity
Treatment regimens: dosage, timing and route of administration, type of treatment within a class of treatments, concomitant treatments
Settings: level of care (primary to tertiary) and experience and specialization of care provider
Modalities of outcomes: type or definition of outcomes and duration of follow up
EBM Is the ability to access, asses and apply the best evidence from systematic research information to daily clinical problems after integrating them with the physician's experience and patient's value.
ASSESSMENT OF BIOMEDICAL LITERATURE
Components of internal and external validity of controlled clinical trials
Internal validity — extent to which systematic error (bias) is minimized in clinical trials
Selection bias: biased allocation to comparison groups
Performance bias: unequal provision of care apart from treatment under evaluation
Detection bias: biased assessment of outcome
Attrition bias: biased occurrence and handling of deviations from protocol and loss to follow up
Requirements, needs
Planning, direction
Information collection
Information Assessment
- Evaluation for accuracy, correctness, relevance, usefulness
- Source reliability assessment (competency and past behavior based)
- Bias assessment (motivators, interests, funding, objectives)
- Conflicts of interest
- Sources of funding, important business relationships
- Grading of individual items (study, report, analysis, article)
Collation of information
- Exclusion of irrelevant, incorrect, and useless information
-Arrangement of information in a form which enables real-time analysis
- System for rapid retrieval of information
External validity — extent to which results of trials provide a correct basis for generalization to other circumstances
Patients: age, sex, severity of disease and risk factors, comorbidity
Treatment regimens: dosage, timing and route of administration, type of treatment within a class of treatments, concomitant treatments
Settings: level of care (primary to tertiary) and experience and specialization of care provider
Modalities of outcomes: type or definition of outcomes and duration of follow up
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ROLE OF PHARMACIST IN PREVENTION & MANAGEMENT OF DRUG INTERACTIONSKomal Haleem
This presentation describes the steps to be performed by a pharmacist to play a major role in prevention and management of drug interactions and includes a case study.
osmotic and secretory diarrhea. acute and chronic diarrhea. small bowel and large bowel diarrhea. amoebic and bacillary dysentery. investigation. treatment.
Evidence-based medicine is the cornerstone of quality clinical practice. It is very important that a critical appraisal of a scientific article. This presentation covers a primary survey & Secondary survey approach to select, read and appraise the article
Evidence Based Practice is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care.
Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal preferences and unique concerns, expectations, and values.
The best research evidence is usually found in clinically relevant research that has been conducted using sound methodology.
An introduction to conducting a systematic literature review for social scien...rosie.dunne
An introduction to conducting a systematic literature review for social scientists and health researchers presented by Luke van Rhoon Health Behaviour Change Research Group, School of Psychology, NUI Galway November 2020
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Evaluation of antidepressant activity of clitoris ternatea in animals
Evaluation of Medical literature
1. Literature EvaluationLiterature Evaluation
Dr.Dr.Ramesh ParajuliRamesh Parajuli
MS (Otorhinolaryngology, Head and Neck Surgery)MS (Otorhinolaryngology, Head and Neck Surgery)
Chitwan Medical College Teaching Hospital, Bharatpur-10,Chitwan, NepalChitwan Medical College Teaching Hospital, Bharatpur-10,Chitwan, Nepal
2. Reasons for Surgeons to Read Medical
Literature:
1.Improve Patient Care
2.Learn about Research
3.Educate Peers and Students about Clinical Care
3. To ensure Best Practice and Treatment for Patients
Doctor must :-
• Access Medical Information
• Acquire New Knowledge
• Achieve Information Mastery in their field
• Without systematic approach to identify & critically appraise clinical research,
doctor might become dependant on inappropriate or outdated information
4. Keeping Medical Informations up to date
Past:
• Reading few journals every month
• Occasional conferences
Present:
• Internet
• Information- available to everyone
5. • Over 10,000 new articles per week are archived
by the National Library of Medicine, and at least twice
that many are published worldwide. (Rudmik LR,2008)
• More than 2 millions/year articles
published in the biomedical press
(scott Brown 7th
edn)
• Most published articles are not translatable
to clinical practice, or
their methods are not clinically sound
6. Publication Bias:-
Articles with Positive findings: Easier to get published
Articles with Negative findings: Author/Editors
• Publication Bias Biased sample of article
7. • As many as 30% of journal articles may contain errors.
(Victor A F,2003)
• Among health professionals, medical literature is the
preferred source of new knowledge
• Medical informations doubles every 5 years
(Castillo D L)
8. To keep up with available clinical evidence, today’s
dedicated physician would have to read 19 articles
everyday, of which only15% would provide information
of practical relevance. (Diana L C,2008)
10. 1.Abstract–overview of
• What the research is about
• What it did
• How it did
• What is found
• What those results mean
2.Introduction –
• Review of previous research
• Rationale for the research
• What the research is aiming to do
3.Method:
• Methods used in the Research
11. 4.Result :
• Describe the result found
5.Discussion:
• What the results actually mean
6.Conclusion:
• Results of several experiments presented and discussed,
Implications of the research
• Recommendations about further research or policy and
practice in the relevant area
12. Knowledge of the Structure and Function of the
Sections of Journal Article:-
• Reduces the time to locate information
• Improves efficiency of reading
• Reduces the time to read the article
13. • Reading Articles Uncritically
Acceptance of Text and Arguments
Flawed, Biased and Subjectively written
• Efficient Reading is not the only skill we need Critical Reading
14. Critical Reading:
Suspending the Judgment on a text until
1.Have understood the message being put forward
2.Evaluated the evidence supporting that message
3.Evaluated the writer’s perspective
15. Critical Reading Checklist
•To avoid reading poor quality literature andTo avoid reading poor quality literature and
mastering irrelevant informationmastering irrelevant information SystematicSystematic
StrategyStrategy
•A skill that a busy otolaryngologist can learnA skill that a busy otolaryngologist can learn
•Critical reading check listCritical reading check list for critical readingfor critical reading
16. Critical Reading for Research Articles
• Are the limitations of the procedures clear?
• Is the methodology valid? (eg.sample size, sampling method)
• Are the results consistent with the objectives?
• Are the claims the author makes about his or her own
research internally consistent?
• Are the diagrams clear to the reader?
17. • Critical Thinking/Critical Analysis:
””thethe intellectually disciplined process of actively and skillfully
conceptualising, applying, analysing, synthesising and/or evaluating
informations gathered from ,or generalised by, observation,
experience, reflection, reasoning or communication ,as a guide to
belief or action (or argument)” (Scriven & Paul 2001)
18. What critical analysis is NOT:
1.A summary of a text
2.A descriptive comment on the text
3.A rehash of the theory learnt in a class
4.A statement of one’s own unsupported views
19. • Harm to pts can be aboutHarm to pts can be about:-:-
Diagnosis:-Diagnosis:-
Therapy:-Therapy:-
Prognosis:-Prognosis:-
• To prevent the harm to the pts:-mostTo prevent the harm to the pts:-most up to dateup to date
knowledgeknowledge availableavailable
20. • Evidence Based Medicine-”evidence-based medicine is the
conscientious, explicit and judicious use of current best
evidence in making decisions about the care of individual
patients” (Sackett et al. 1996 )
21. • CONSCIENTIOUS
- To do more good than harm
- To do right things in right way
- Carefulness and attention
• EXPLICIT
- Openness and transparency
-To evaluate and criticize
the methods used
- Doctor- Patient relationship
• JUDICIOUS
- To evaluate and weigh
the evidence of the work
-To consider Benefit &
balance it against harm
• Current Best Evidence
22. Evidence Based Practice (EBP)
• Begins and ends with patients
• Integrating individual clinical expertise with the best available
external clinical evidence from systematic research
• Application of the knowledge to the prevention, diagnosis or
management of the disease
23. Evidence Based Medicine –practice of medicine with an
emphasis relying on the medical literature for clinical
decision making
EBM approach-
• Improves ability to evaluate clinical literature
• Enhances life long learning skills in day to day medical practice
• Keeping up to date
• Continuing medical education (CME)
24. Purpose of EBM-
• To propagate the evidence but not to replace individual’s
clinical experience
• One shouldn’t expect clinical practice to be 100%evidence
based-better patient care shouldn’t be compromised by not
counting on evidence when it is readily available by different
sources.
25. • EBM is key component of modern medical practice
• EBM is necessary but not sufficient
• Otolaryngologists should acquire the fundamentals skills
of searching, appraising, and synthesizing, required to
practice EBM and should do so with the same diligence
they apply to learning surgical skills
26. Critical Appraisal –one aspect of EBM
• The ability to apply the principals of analysis
• To identify those studies which are unbiased and valid.
Critical Appraisal of Research Studies helps to:-
1.Improve patient care
2.Improve teaching
3.Become a better researcher
4.Prepare for journal club
5.Gain respect among the peers
27. Practising Evidence Based Health Care:-
EBM process involves 5 steps
1.Ask clinical question:-formulation of “P I C O” question
2.Search literature
3.Appraisal (critically evaluate the literature)
4.Share the knowledge
5.Apply to the patient
28. • Forming Answerable Questions:
1.Background questions:-understand the problem in general
2.Foreground questions:-decision making questions
29. • The PICO Format for Foreground Questions
1.P=Patient and Problem (population-kids, women, patients)
2.I=Intervention( test)
3.C=Comparison intervention (Control group)
4.O=Outcome
30. • To avoid reading poor quality literature and mastering irrelevant
information Systematic Approach
1.Retrieve
2.Review
3.Reject
4.Read
31.
32. • 5s model for Evidence-Based Health Care
Decisions (Hynes R B; ACP J Club 2006;145:A8)
33. To answer a particular question: evidence Based Research
Resources
1.The cochrane collaboration
2.National library of medicine-gateway
3.Open clinical
4.bestBETs
Selection of medical database:
• Type of question
• Ease of use for a particular problem
• Need to limit the search for highest quality studies
34. • Selecting an Article: Filtering Process
1.Primary Survey (initial evaluation and brief overview)
(A) Analyse the Title :
(B) Review the list of authors:
(C) Read the summary or abstract beginning with conclusion:
• If the conclusion if valid ,important to me?
• Results if true, how useful they are?
• Is the primary outcome measured important for me?
• Do the interventions make sense?
• Can the information be generalised to my patients?
35. Secondary Survey:
1.Introduction :
• Problem under study, context of the study, reasons for conducting
study
• Importance of the topic, what is known and what is unknown about
the topic
• Specific questions (objective, goal of the study, hypothesis) to be
evaluated
• Study sample, primary outcome & intervention being evaluated
• Method design
• Conclusion shouldn’t extend beyond the stated objective
36. 2.Methods:
• Research design-descriptive or comparative study
• Single or multicenter
3. Study Sample:
• How were the subjects and controls selected?
• Are the inclusion & and exclusion criteria sufficiently clear to
describe the target population?
4.Treatment Allocation:
• Randomization
• Masking (blinding)
37. 5.Outcomes:
primary outcome-all studies
secondary outcome-some studies
• How it was measured?
• was the measurement free of bias ?
• How reproducible were the results?
• How to standardize measurements & to minimize inter-observer variability?
6.Statistical Analysis:
• Statistical Tests
38. 7.Results:
• Tables and Figures,
• How many pts eligible for the study?
• How many enrolled?
• How many completed?
8.Discussion :
• Author’s interpretation of clinical relevance
• Comparison with previous studies, similarities & differences
• Limitation of the study
• Suggest new directions for appropriate study
39. 9.Conclusion:
• Must consistent with the study objective
• Justified by the study results
• Shouldn’t over generalize the results of the study
40. • If there is not concealment of Randomizationmay
exaggerate efficacy of the treatment by as much as 30% more
• If there is no Blinding may exaggerate the effectiveness of
the treatment by 15%
• If <80% pts Followed Upresults become meaningless
41. Types of Study by Content:
1.Evaluation of a new therapy
2.Evaluation of a new diagnostic test
3.Determinnation of the etiology of a condition
4.Prediction of the outcome
5.Natural course of a condition
42. Levels of evidence
• Level 1 : 1a-SR(homogeneity) of RCTs
1b-Individual RCT
1c-All or None
• Level 2 :2a-SR(with homogeneity) of Cohort studies
2b-Individual Cohort Study (including low quality RCT; eg
<80% follow up)
2c-Outcomes research; ecological studies
• Level 3 3a-SR(with homogeneity) of case control studies
3b-Individual case-control study
• Level 4 - Case Series(& poor quality cohort & case control studies)
• Level 5 - Expert opinion
43. Grades of Recommendation
• Grade A- consistent level 1 studies
• Grade B- consistent level 2 or 3 studies or
extrapolations from level 1 studies
• Grade C- level 4 studies or extrapolations
from level 2 or 3 studies
• Grade D- level 5 evidence or troublingly
inconsistent or inconclusive studies of any
level
44. once the trial or trials have been found that
seems to answer the questions check three
things:
1.Is the study valid?
2.What are the results?
3.Can these be applied to my patients?
45. (I) Appraising the Diagnostic Articles:
1.Is the study valid?
Did the authors answer the questions?
1.What were the characteristics of the groups?
2.Is it clear how the test was carried out?
3.Is the test result reproducible?
4.Was the reference standard (gold standard) appropriate?
5.Were the reference standard & the diagnostic test interpreted blind
and independently of each other?
6.Was the reference standard applied to all patients?
7.Was the test evaluated on an appropriate spectrum of patients?
46. 2. What were the results?
• Are the sensitivity/specificity and/or likelihood ratios presented?
• Could the results have occurred by chance?
• Are there confidence limits?
Likelihood Ratio :-
• Likelihood Ratio (+ve results)= sensitivity
(100% - specificity)
• Likelihood Ratio (-ve results)= (100% - sensitivity)
specificity
If LR > 10 + ve
< 1 - ve
47. 3. Will the Results help my Patients?
1.Is the diagnostic test available, affordable, accurate & precise in
my setting?
2.Are the results applicable to my pts? Do my pts have a similar
mix of disease severity & competing conditions?
3.Will the results change my case management ?will the
information gain be sufficient to change a clinical decision (rule
in or rule out)?
4.Will patients be better off as a result of performing the test?
48. (II) Appraising Therapy Articles
1.IS THE STUDY VALID?
Did the authors answer the questions?
1.What were the characteristics of the pts?
2.Were the groups similar at the start of the trial?
3.Aside from the experimental treatment, Were the groups treated equally?
4.What was the treatment & what was it compared against placebo?
5.Was randomization used?
6.Were all pts followed up at its conclusion?
7.Wre they analyzed in the groups to which they were randomized?
8.Were blinding used?
9.Was the length of study appropriate?
49. 2.WHAT WERE THE RESULTS?
Event rates-control event rate (CER), experimental event rate (EER)
Relative risk
CER-EER
Relative risk reduction (RRR) = ------------------
CER
Absolute risk reduction (ARR) = CER- EER
Number needed to treat (NNT) = 1
-------
ARR
50. 3.WILL THE RESULTS HELP MY PATIENTS?
1.Can the results be applied to my patient care?
Would my pts eligible for the study?
Are there any reasons why the results shouldn’t be applied to my
pts?
2.Were all clinically important outcomes consider?
3.Are the likely treatment benefits worth the potential harm and
costs?
51. (III) Appraising the Systematic Review
1.IS THE REVIEW VALID?
Did the authors answer the questions?
1.What databases & other sources did the authors of this review search?
2.What were their eligibility criteria (inclusion & exclusion)? do these seems
appropriate?
3.Was there independent data extraction of the result by the reviewers (then
compared later)?
4.Is there a description of the quality of each trial?
5.Were the results consistent from study to study (homogeneous)?
52. (2)WHAT Were The Results?
If the results of the studies have been combined, was
it reasonable to do so?
consider whether:
• the results of each study are clearly displayed?
• the results were similar from study to study?
How are the results presented and what is the main
result?
How the results are expressed (eg. odds ratio, relative risk etc)
How precise are these results?
53. 3 .CAN I APPLY EVIDENCE FROM THIS SYSTAMATIC REVIEW IN
CARING FOR MY PTS?
• Whether the population sample different from my population ?
• Whether my local setting differs ?
• Were all clinically important outcomes considered?
• Should policy or practice change as a result of the evidence
contained in this review?
• Whether any benefit reported outweighs any harm/or cost
54. (IV) Critical Appraisal Skills for the Cohort Study
1.ARE THE RESULTS VALID?
• Did the study address a clearly focused issue?
• Did the authors use an appropriate method to answer their
question?
• Was the cohort recruited in an acceptable way?
• Was the exposure accurately measured to minimize bias?
• Was the outcome accurately measured to minimize bias?
55. • Have the authors identified all important confounding
factors?
• Was the follow up of subjects complete enough?
• was the follow up of subjects long enough?
2.WHAT ARE THE RESULTS?
• What are the results of this study?
• How precise are the results?
• Do I believe the results?
56. 3.WILL THE RESULTS HELP ME LOCALLY?
• Can the results be applied to the local population?
• Do the results of this study fit with other available evidence?
57. (V) Appraisal of a Case Control Study
1.ARE THE RESULTS OF THE STUDY VALID?
1.Did the study address a clearly focused issue?
2.Did the authors use an appropriate method to answer their question?
3.Were the cases recruited in an acceptable way?
4.Were the controls selected in an acceptable way?
5.Was the exposure accurately measured to minimize bias?
6.(A)what confounding factors have the authors accounted for?
(B) Have the authors taken account of the potential confounding factors in
the design and/or in their analysis?
58. 2.WHAT ARE THE RESULTS?
7.What are the results of this study?
8.How precise are the results?
how precise is the estimate of risk?
9.Do I believe the results?
59. 3.WILL THE RESULTS HELP ME LOCALLY?
10.Can the results be applied to the local population?
11.Do the results of this study fit with other available evidence?
60. REFERENCES:
1.Scott-Brown’s Otorhinolaryngology, Head & Neck Surgery(7th
edition)
2.Critical appraisal skills programme (CASP)-making sense of evidence
public health resource unit;england(2006)
3.Evaluating the literature (emedicine)
4.Unilearing-University of wollongong, australia
5.Evidence based medicine (EBM)-what, why and how(KUMJ 2003)
6CEBM-EBM tools
7.Assesing the medical literature: let the buyer beware
8.Knoweledge managemet:how to keep up with the literature
9.Literature review(st.kate’s libraries guides)
10.How to evaluate the literature(stanford university)
11.Guidelines for evaluating writing about literature
(john jay college of criminal justice)
12.Critical analysis-so what does that mean(university of bradford)
13.Evaluating the medical literature(clista clantin 2009)
14.Literature evaluation (hussain al awami)
61. 16.How to read a paper? (BMJ)
17.Crafting the literature review (massey university;2006)
18.Argument based medical ethics
19.Assessment of the critical appraisal (american journal of
surgery,2004)
20.Teaching critical appraisal skills to medical students in obstetrics and
gynecololgy (university of california OBGYN department)
21.A simple method for evaluating clinical literature (JF Robert)
22.Evidence based medicine literature evaluation questions (washington state
university,2006)
23.Evidence based medicine capitol conference 2007