Evidence-Based Medicine

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H Harms <strong>Evidence</strong>-based healthcare resources often have great difficulty in providing good quality evidence on harms. Most RCTs are not designed to assess harms adequately: the sample size is too small, the trial too short, and often information on harms is not systematically collected. Often a lot of the harms data are in the form of uncontrolled case reports. Comparing data from these series is fraught with difficulties because of different numbers receiving the intervention, different baseline risks and differential reporting. We aim to search systematically for evidence on what are considered the most important harms of an intervention. The best evidence is from a systematic review of harms data that attempts to integrate data from different sources. However, because of these difficulties and following the maxim “first one must not do harm” we accept weaker evidence. This can include information on whether the intervention has been either banned or withdrawn because of the risk of harms. Hazard ratio (HR) Broadly equivalent to relative risk (RR); useful when the risk is not constant with respect to time. It uses information collected at different times. The term is typically used in the context of survival over time. If the HR is 0.5 then the relative risk of dying in one group is half the risk of dying in the other group. If HRs are recorded in the original paper then we report these rather than calculating RR, because HRs take account of more data. Heterogeneity In the context of meta-analysis, heterogeneity means dissimilarity between studies. It can be because of the use of different statistical methods (statistical heterogeneity), or evaluation of people with different characteristics, treatments or outcomes (clinical heterogeneity). Heterogeneity may render pooling of data in meta-analysis unreliable or inappropriate. Finding no significant evidence of heterogeneity is not the same as finding evidence of no heterogeneity. If there are a small number of studies, heterogeneity may affect results but not be statistically significant. Homogeneity Similarity (see heterogeneity). -36-
I Incidence The number of new cases of a condition occurring in a population over a specified period of time. Inclusion / exclusions We use validated search and appraisal criteria to exclude unsuitable papers. Authors are then sent exclusion forms to provide reasons why further papers are excluded. Intention to treat (ITT) analysis Analysis of data for all participants based on the group to which they were randomised and not based on the actual treatment they received. Where possible we report ITT results. However, different methods go under the name ITT. Therefore, it is important to state how withdrawals were handled and any potential biases, e.g. the implication of carrying last result recorded forward will depend on the natural history of the condition. L Likelihood ratio (L R) Is the likelihood of a given test result in a patient with the target disorder compared to the likelihood of the same result in a patient without that disorder. The ratio of the probability that an individual with the target condition has a specified test result to the probability that an individual without the target condition has the same specified test result. LR>1 indicates and increased likelihood of disease, LR
Page 1 and 2: Highlights On Evidence-Based Medici
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Page 5 and 6: Index Contents Page No. - Preface t
Page 7 and 8: Preface to the Sixth Edition Praise
Page 9 and 10: EVIDENCE-BASED MEDICINE Introductio
Page 11 and 12: The practice of evidence-based medi
Page 13 and 14: A systematic review is a critical a
Page 15 and 16: Strength of Recommendation Taxonomy
Page 17 and 18: TABLE 2. Assessing Quality of Evide
Page 19 and 20: Strength of Recommendation Based on
Page 21 and 22: In order to obtain the best evidenc
Page 23 and 24: The following are all common source
Page 25 and 26: (Suggestive Guideline) STRATEGIC PL
Page 27 and 28: GLOSSARY OF TERMS IN EVIDENCE-BASED
Page 29 and 30: 9. Where the condition is acute and
Page 31 and 32: Cohort studies should not be includ
Page 33 and 34: Crossver-sectional Study The observ
Page 35: Experimental study A study in which
Page 39 and 40: until the clinician and patient are
Page 41 and 42: O Observational studies Observation
Page 43 and 44: patients. POEMs are selected from r
Page 45 and 46: Prevalence The proportion of people
Page 47 and 48: Relative risk (RR) The number of ti
Page 49 and 50: Standardised mean difference (SMD)
Page 51 and 52: W Weighted mean difference (WMD) A
Page 53 and 54: Evidence-Based Medicine Resources A
Page 55 and 56: (with ACP Journal Club). The Cochra
Page 57 and 58: C- Resources that will help you to
Page 59 and 60: References For further readings 1.
Page 61 and 62: 28. Mulrow C, Cook D. Integrating h
Page 63 and 64: 58. Khoja TA. Glossary of Health Ca
Page 65 and 66: 85. Lorenz KA, Ryan GW, Morton CS.
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Evidence-Based Medicine

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