EBM --- Journal Reading

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• EBM --- Journal Reading

Presenter??? Date2005/10/27
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Users Guides to the Medical Literature?. How
to Use a Clinical Decision Analysis? B. What
are the Results and Will They Help
Me in Caring for My Patients?
W. Scott Richardson, MD. Allan S. Detsky, MD,
PhD, for the Evidence-Based Medicine Working Group
JAMA May 24, 1995 273, 20
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Analyzing the Analysis

• 1. Are The Results Valid?
• 2. What Are The Results?
• 3. Will The Results Help Me in Caring For My
  Patients?

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In the baseline analysis, does one strategy
result in a clinically important gain for
patients? if not,is the result a Toss-up?
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Three possible results

• 1stgt2nd
• 1stlt2nd
• 1st2nd toss-up

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• Baseline
• Refer to a set of numbers for probability
• that the analyst believes are closest to the
• actual state of affairs
• Expected utility
• Comparing the overall benefits expected
• from pursuing each strategy
• How to calculate?

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How strong is the Evidence used in the analysis?
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• Probabilities used in clinical decision analyses
  are estimates, taken mostly from the published
  literature
• Judge study quality by applying criteria akin to
  those in the other articles in this series,
  whether for primary studies of therapy,
  diagnosis, harm, prognosis, or for integrative
  studies, such as overview
• Ideally, every probability estimate at every node
  in the tree is supported by precise estimates
  from primary and integrative studies of high
  methodological quality

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Could the Uncertainty in the evidence change the
result?
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• For any clinical variable, can calculate the
  value or threshold
• Sensitive-result of the analysis would change by
  choosing different values for one of the
  variables
• Robust doesnt change the result (confident)

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Will The Results Help Me In Caring For My
Patients?

• Do the probability estimates fit my patients
  clinical features?
• Do the utilities reflect how my patients would
  value the outcomes of the decision?

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Do the probability estimates fit my patients
clinical features?

• Look for the description of that patients
  condition
• Track down the references and review the
  inclusion and exclusion criteria
• Review the results of the sensitivity analyses
• Look in the text for the authors description of
  their systematic review of the literature

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Do the utilities reflect how my patients would
value the outcomes of the decision?

• Examine the one-way and multiway sensitivity
  analyses that use a wide range utility estimates
  to see how your patients patients values will
  affect the final decision

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Thanks for your attention