1) Evaluating scientific literature is important due to the huge volume of new articles published each year. It is necessary to prioritize what to read in order to acquire the most relevant information.
2) There are different types of information sources, including primary sources which are original research articles, secondary sources which discuss primary sources, and tertiary sources which discuss secondary sources.
3) Evidence-based medicine tools like the evidence pyramid and evidence boxes can help evaluate different types of studies and quickly determine the appropriate level of evidence for answering clinical questions.
"Hierarchies of Evidence" is an important but problematic concept for medical professionals to understand as it underpins their capacity to be effective practitioners and researchers.
a brief overview about how and why to practice evidence based medicine, its clinical application, what it is and what it is not? benefits and challenges
Jan Hrabal: Evaluation of medical information quality #bcs2015KISK FF MU
Talk given at the BOBCATSSS 2015 conference - http://www.bobcatsss2015.com/.
The paper deals with the concept of quality of health-related information in the internet environment. It brings definitions of indicators of medical information quality, which are set into the methodics for evaluation of medical information quality on Czech websites. The methodics is divided in two parts: one for non-expert sources in common online environment designed for laymen and one extended version designed for experts, which includes also criteria for evaluation of research papers and reviews.
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
"Hierarchies of Evidence" is an important but problematic concept for medical professionals to understand as it underpins their capacity to be effective practitioners and researchers.
a brief overview about how and why to practice evidence based medicine, its clinical application, what it is and what it is not? benefits and challenges
Jan Hrabal: Evaluation of medical information quality #bcs2015KISK FF MU
Talk given at the BOBCATSSS 2015 conference - http://www.bobcatsss2015.com/.
The paper deals with the concept of quality of health-related information in the internet environment. It brings definitions of indicators of medical information quality, which are set into the methodics for evaluation of medical information quality on Czech websites. The methodics is divided in two parts: one for non-expert sources in common online environment designed for laymen and one extended version designed for experts, which includes also criteria for evaluation of research papers and reviews.
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
Hospitality online, net zo belangrijk als de Hospitality offline! Waarom doen we dit niet? In deze presentatie vindt je een aantal kern begrippen en tips om te starten met online luisteren. Social Media is voor iedereen, kies en ga ermee aan de slag!
Biostatistics is one of the most unavoidable area in the modern day practice of evidence based medicine . In the ppt , trying to give a glimpse on how a clinician should approach Biostatistics
Why bother with evidence-based practice?PaulGlasziou
An introduction to evidence-based medicine (EBM) with short section in history and why EBM? Then a brief overview of the 4 steps of EBM.
These slides have been used for starting a 1-day workshops in EBM
MedicReS Winter School 2017 Vienna - Importance of Selection of Outcomes - Ma...MedicReS
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Mariana Chavez Mac GregorMD, MSc.
Assistant Professor, Health Services Research Department
Breast Medical Oncology Department
Evidence based decision making in periodonticsHardi Gandhi
INTRODUCTION TO EVIDENCE BASED DENTISTRY
EVIDENCE BASED PERIODONTOLOGY
NEED, PRINCIPLES, GOALS AND ADVANTAGES OF EBDM
SKILLS NEEDED FOR EBDM
ASSESING THE EVIDENCE
INCORPORATING INTO THE PRACTICE
The lecture explains the steps of thinking while applying the principles of evidence based medicine on radiology.An example from real life is given and how to apply this type of thinking in order to achieve the best results.
This presentation covers the guidelines for follow up of patients with Hodgkin's lymphoma after they achieve complete remission and complete their therapy.
This is an overview of the adjuvant Tx of pancreatic CA. A Lecture that was given in the annual conference of NCI Egypt: 45 years against cancer in Egypt. Cairo, April, 2013
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
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Evaluation of scientific literature
1. EVALUATION OF RELEVANT
SCIENTIFIC LITERATURE
Ahmed Zeeneldin
Associate Prof of Medical Oncology
Master of Clinical Research, Liverpool, UK
2. Why should we evaluate the literature?
• PubMed
• 2011: ~ 1000 000 new articles added
• Dec 2011: >100 000 new articles added
• Anthracycline AND chemotherapy
AND breast cancer: >8000 articles
• Thus:
• little time and huge literature volume
• Prioritize
• Evaluate what you read/hear
3. Acquiring information
• The ‘push’ method
• lectures, seminars,
• reading journals
• no control over the content
• The ‘pull’ Method
• You search for answers
for your questions
5. Evidence 3-dimensions (apq)
• Author (a)
• Known
• Expert
• Publisher (p)
• Peer-reviewed
• Non-reviewed
• Quality of evidence (q)
• On the fly: EBM guides
• Comprehensive
6. Literature assessment/appraisal
• Pre-appraised sources
• Up-to-date
• Trip database
• Rehab+ database
• Risk lies on expert authority (a & P)
• Appraise it yourself (q)
- Rapidly: EBM tools
- Extensively: critical
appraisal tools
7. Types of Information Sources
• Primary Sources: original research
• Not appraised
• Secondary Sources: about primary
• Appraised
• Tertiary Sources: about secondary
• Appraised
8. Primary Sources
• Original materials
• Not been filtered through interpretation, condensation
• Not evaluated by a second party;
• Examples:
• Original journal articles
• Theses
9. Secondary Sources
• Sources about primary, or original, information,
• Modified, selected, or rearranged for a specific purpose or
audience
• Examples:
• Textbooks
• Review articles
11. Steps of reading literature
• You may start by 3ry or 2ry information recourses
• Textbook
• Review article
• Encyclopedia
• handbook
• To get overview of the topic
• Then you use the bibliography
to locate 1ry sources
• Or search directly for 1ry sources
12. Evidence-based medicine (EBM) tools
• EBM: is a process to systematically
• FIND,
• APPRAISE, and
• APPLY
• research findings to clinical decisions
14. Evidence Pyramid
• I - Controlled and randomized
• II-I Controlled but not randomized
• II-2 Cohort or case control
• II-3 Multiple time series
• III- Expert opinion or case study
15. 2011 OXFORD CENTRE FOR EVIDENCE-BASED
MEDICINE (OCEM) LEVELS OF EVIDENCE
EVIDENCE BOXES
16. 2011 OCEBM Levels of Evidence (Evidence Boxes)
If you have limited time, where do you begin
searching for evidence?
- hierarchy of the likely best evidence
- for busy people (few minutes to few hours)
17. PubMed search for
“ Anthracycline AND chemotherapy AND (breast cancer) ” plus some filters
Type Term used No. of articles
All articles (no filter) 8066
SR Systematic review 32
RCT "random allocation" [MeSH] 120
DBRCT double blind method [mh] 58
Cohort "cohort studies" [MeSH] 1379
Case-control "Case-Control Studies"[Mesh] 521
Case report Case Reports [Publication Type] 568
18. Evidence according to question
• Incidence
(How common is the problem?)
• Local surveys with random sampling OR consensus
• Diagnosis
(Is this diagnostic or monitoring test accurate?)
• SR of cross sectional studies with reference standard
• Prognosis
(What will happen if we do not add a therapy?)
• SR of inception cohort studies
• Treatment Benefits
(Does this intervention help or harm?)
• SR of RT
• Screening
(Is this (early detection) test worthwhile
• SR of RT
19. Critical appraisal of study reports
• Systematic Review
• Diagnostics
• Prognosis
• RCT
•
20. Systematic Review Appraisal
• What is the question (PICO)?
• Were important and relevant studies missed?
• Were criteria to select articles appropriate?
• Were the quality of included articles assessed?
• Were the results similar from study to study?
• What were the results? and how they are
presented?
21. Diagnostic test study appraisal
• Was the diagnostic test evaluated in a representative
spectrum of patients?
• Was the reference standard applied regardless of the
index test result?
• Was there an independent, blind comparison between
the index test and an appropriate reference ('gold')
standard of diagnosis?
• Are test characteristics presented?
• Accuracy: sensitivity and specificity
• Performance in population: PPV and NPV
• Details to replicate the test?
22. Critical appraisal of Prognostic studies
• Were patients representative and assembled at a
common point?
• Was patient follow-up sufficiently long and complete?
• Were outcome criteria either objective or applied in a
‘blind’ fashion?
• If subgroups with different prognoses are identified, did
adjustment for important prognostic factors take
place?
• How likely are the outcomes over time?
• How precise are the prognostic estimated?
• Are the results applicable to my patients?
23. RCT appraisal
• What question did the study ask (PICO)?
• Was the assignment of patients to treatments
randomised?
• Were the groups similar at the start of the trial?
• Aside from the allocated treatment, were groups treated
equally?
• Were all patients who entered the trial accounted for?
and were they analysed in the groups to which they were
randomised?
24. RCT appraisal
• Were measures objective or were the patients and
clinicians kept “blind” to which treatment was being
received?
• How large was the treatment effect?
• How precise was the estimate of the treatment effect?
• Will the results help me in caring for my patient?
25. Steps of EBM
1. asking questions
2. searching for answers
3. critically appraising the results
_____________________________
4. determining applicability to practice
5. integrating data with experience
6. involving patient in decisions
26. Asking questions
1) what is the question about?
• Therapy, diagnosis, prognosis, aetiology/harm, screening etc
2) what is the type of question?
- background Q (topic)
- foreground Q (patient)
3) how can questions be structured to facilitate a search
for precise answers?
PICO’ components:
• Patient group/Population
• Intervention
• Comparison
• Outcome
27. Examples of Focused Questions
1 2 3 4
Patient or Intervention Comparison Outcomes
(a cause, prognostic
Problem factor, treatment, etc.) Intervention
(if necessary)
In patients with MBC does FEC regimen Compared to CMF Yield better OS
Med Oncology
regimen rates?
In patients with early BC Does BCS Compared to MRM Lead to higher
Surgical
recurrences and
Oncology
lower OS?
In patients with operable Does IO RT Compared to PO RT Yield higher
Radiotherapy
BC recurrences?
In patients with ovarian Does HEP4 Compared to CA125 Leads to earlier
Clinical cancer diagnosis of
Pathology recurrence?
In normal people Does smoking Compared to no Increase risk of
Epidemiology
smoking lung cancer
28. How to Conduct a Computer Search
1. Specify the research problem 1. Honey and cancer
2. Select the databases 2. PubMed
3. Select the key concepts, 3. Honey AND cancer
operators, limits
4. ENTER: 198 records
4. Conduct the search
5. Honey OR bees
5. Increase or decrease your total AND cancer: 281
results Honey AND cancer
6. Review the citation list AND treatment: 129
29. Determining the Level of Evidence
• Quickly:
• Evidence box according to question
• Thoroughly (critically appraise according to study
type):
• Relevance (related):
• applicability of the evidence to my problem
• Validity (correct):
• the extent to which a concept, conclusion or measurement is well-
founded and corresponds accurately to the real world
31. Trial Validity
• Internal: proper study
• Did the study measure what it is meant to?
• Do we trust the results?
• External: generalizability of results
32. Making decisions
• Define the population and intervention
• Patients’ characteristics
• Intervention: price and availability, training
• Search for and understand the biases
• Critical appraisal
• Interpret the findings and apply them to your patient
• Sample size
• Summary statistic:
• Probablity (p) and confidence of the results (CI)
33. Conclusion
• Pre-appraised literature may be the
main source of information for
undergraduate students
• However, graduates and faculty staff
should be able to appraise
information both quickly (EBM tools)
and thoroughly (critical appraisal
tools)
• APQ 3-dimension concept
34. Recommendation
• I suggest that principles of EBM be taught to all NCI
students
• By whom?
• Concerned Departments?
• Epidemiology/Biostatistics Department?