Evidence-Based Medicine

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Open label trial A trial in which both participant and assessor are aware of the intervention allocated. Outcomes This generally means mortality, morbidity, quality of life, ability to work, pain, etc. Laboratory outcomes are avoided if possible. Even if there is a strong relationship between a laboratory outcome marker and a clinical outcome it is not automatic that it will hold under new conditions. Outcomes that are markers for clinically important patient centred outcomes are often called surrogate outcomes (e.g. ALT concentrations are a proxy for liver damage following paracetamol overdose). P PICOt Population, intervention, comparison, and outcome, all with a time element (PICOt). The current reporting requirements of systematic reviews are: how many RCTs, how many participants in each, comparing what with what, in what type of people, with what results. Each variable needs a temporal element, (how old are the participants, how long is the treatment given for, when is the outcome measured). In the future, we hoping to have a brief description in the text with full details accessible from the website. Placebo A substance given in the control group of a clinical trial, which is ideally identical in appearance and taste or feel to the experimental treatment and believed to lack any disease specific effects. In the context of non-pharmacological interventions, placebo is usually referred to as sham treatments. Placebo is not the same as giving no treatment and can induce real physiological changes. Whether it is appropriate to compare the experimental with placebo or no treatment depends on the question being asked. Where possible we report on the specific intervention given as a placebo. We include, if available, information is available on whether participants or clinicians could distinguish between placebo and the intervention. POEMs The acronym POEMs stands for Patient-Oriented <strong>Evidence</strong> that Matters, and refers to summaries of valid research that is relevant to physicians and their -42-
patients. POEMs are selected from research published in more than 100 clinical journals. Each month, a team of family physicians and educators reviews these journals and identifies research results that are important and can be applied to day-to-day practice. The valid POEMs are summarized, reviewed, revised, and compiled into InfoRetriver, part of the InfoPOEMs, Inc. POEMs have to meet three criteria: they address a question that primary care physicians face in daytoday practice; they measure outcomes important to physicians and patients, including symptoms, morbidity, quality of life, and mortality; and they have the potential to change the way physicians practice. Studies that do not meet these criteria cannot be POEMs. Types of Studies Selected: • Studies of treatments must be randomized, controlled trials. • Studies of diagnostic tests, such as in a laboratory or as part of the physical examination. • Only systematic reviews, including meta-analyses, are considered rather than nonsystematic reviews. • Studies of prognosis that identify patients before they have the outcome of importance and are able to follow-up at least 80 percent of the study population. • Decision analysis involves choosing an action after formally and logically weighing the risks and benefits of the alternatives. • Qualitative research findings are reported if they are highly relevant, although specific conclusions will not be drawn from the research. Positive likelihood ratio (LR+) The ratio of the probability that an individual with the target condition has a positive test result to the probability that an individual without the target condition has a positive test result. This is the same as the ratio (sensitivity/1- specificity). Positive predictive value (PPV) The chance of having a disease given a positive test result (not to be confused with sensitivity, which is the other way round. PPV is the proportion of the people with a positive test who have disease. Also called the post-test probability of disease after positive test See also SpPins and SnNouts. -43-
Page 1 and 2: Highlights On Evidence-Based Medici
Page 3 and 4: -3-
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 and 36: Experimental study A study in which
Page 37 and 38: I Incidence The number of new cases
Page 39 and 40: until the clinician and patient are
Page 41: O Observational studies Observation
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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