How to read a paper

1
How to read a paper

• The basics of evidence based medicine

2
Finding evidence

• Formulate a clinical question
• Devise a search strategy
• Identify and evaluate sources
• Use sources effectively
• Revise search strategy if it is needed
• Store results

3
Clinical effectiveness defining the question
4
Question formulation

• Formulating a question and then devising a
  search strategy can be used for any database
• Think about what you really want to know e.g. My
  patient wants to know whether there is any
  evidence that taking some form of physical
  exercise after having a heart attack helps people
  live longer --the patient is a man
• Try to break down the request into categories of
  patient/problem, intervention, comparison and
  outcome - also called PICO.
• The comparison category is optional.

5
In men who have had a heart attack, does an
exercise programme increase their survival rate?

• Patient heart attack, heart disease, myocardial
  infarction
• men, male
• Intervention exercise programme, physical
  exercise, sport, aerobic exercise
• Outcome decreased mortality, increased survival
  rate, live longer

6

• Classifying your question into domain
• Therapy
• Diagnosis
• Prognosis
• Cost effectiveness
• Harm
• Quality of life

7
What is the best evidence?

• Friend once told me
• Group of old Professors
• Case series
• Systematic Review
• RCT
• Case control trial
• Case

8
Clinical Scenario

• A 60 year old woman uses diclofenac for
  osteoarthritis. It helps the pain a lot. However
  she complains of some minor gastric upset with
  the medication. You know the diclofenac is
  putting her at risk of developing a bleeding
  ulcer. She wants to keep taking the medication
  because it provides so much pain relief. You
  wonder if there is something you can do to
  prevent her from developing an ulcer.

9
Some possible structured questions

• In a 60 year old women who is on diclofenac, what
  is the most effective way of decreasing the
  likelihood of the development of a peptic ulcer?
• In a 60 year old women who is on diclofenac, does
  taking the medication on alternate days decrease
  the likelihood of the development of a peptic
  ulcer?