Title: What did we learn to teach
1What did we learn to teach?
- Defining Evidence-Based Practice
- Steps of the EBHC Process
- Rapid Appraisal of Intervention Studies
2(No Transcript)
3Steps in EBMThe Five Ah!s
- Ask an answerable question
- Acquire the best evidence
- Appraise the evidence for
- Validity
- Impact (size of the benefit)
- Applicability
- Apply the results
- Integrate with clinical expertise and patient
values - Assess our effectiveness and efficiency
- keep a record improve the process
4Librarians Role
- Provide instruction and resources to support
first 2 steps of EBM Process - At ESJH developed online Web tutorial covering
- well-built questions
- evidence pyramid
- search strategies
- appraised resources
5Evidence-based Healthcare Tutorial
- Available at www.exempla.org
- Click on the Education tab
- Choose EBM online course
6 Rapid Appraisal of Intervention Studies
- Examine title, abstract, conclusion for
relevance - Does it answer the question?
- Do the study group characteristics match our
patient? - Ask three questions
- Is the study valid? (Internal Validity)
- What are the results?
- Applicability Will the results help the patient?
(External Validity)
7Rapid Appraisal QuestionsAre the results of the
study valid?
- Criteria for internal validity
- Randomization
- Similar groups
- Follow-up
- Intention-to-treat
- Equal treatment
- Blinding
8Rapid Appraisal QuestionsAre the results of the
study valid?
- Randomization random allocation of patients to
study groups. (Methods) - Each patient has equal chance of being assigned
to any group. Best way to equalize all factors,
known and unknown.
9Rapid Appraisal QuestionsAre the results of the
study valid?
- Similarity of groups (Results)
- Patients in one group are as likely to possess a
given characteristic as patients in another - Look for table of Baseline Characteristics or
measure of differences between groups (p value)
10Rapid Appraisal QuestionsAre the results of the
study valid?
- Follow-up all patients accounted for at
conclusion of trial (Results) - Loss to follow-up lt20
- Compare number of patients randomized to number
computed in analysis
11Rapid Appraisal QuestionsAre the results of the
study valid?
- Intention-to-treat analysis (Results)
- Patients analyzed in groups to which they were
randomized even of they discontinue, never
receive the intervention or crossover
12Rapid Appraisal QuestionsAre the results of the
study valid?
- Equal treatment (Methods)
- Apart from the intervention all groups should
receive the same care
13Rapid Appraisal QuestionsAre the results of the
study valid?
- Blinding (Methods)
- Participants (physicians, patients, researchers)
unaware of treatment allocation - Most important if outcome is subjective (symptoms
or function) rather than objective (death).
14Rapid Appraisal Questions
- Is the study valid?
- Decide whether the internal validity is
sufficient to allow firm conclusions. - All studies have some flaws but are these flaws
sufficient to discard the study?
15Rapid Appraisal QuestionsWhat were the results
of the study?
- How large was the treatment effect?
- Relative Effects
- Relative Risk (RR)
- Relative Risk Reduction (RRR)
- Absolute Effects
- Absolute Risk (AR)
- Absolute Risk Reduction (ARR)
- Number Needed to Treat (NNT)
16Applicability Will the results help the patient?
- How do the benefits and harms weigh up in this
patient? - Higher or lower risk than the study population?
- Is the patient so different that the results
cannot apply - Patients circumstances, concerns and goals
- Is the treatment feasible in the local setting?