The GATE :a Generic Appraisal Tool for Epidemiology ~????????~

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The GATEa Generic Appraisal Tool for
Epidemiology????????
??????? ??????? ? ? ? ?
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Evidence-based practice?
3
Evidence-based practice?
4
EBP?5??step???(???????????)
1. ??????????????????????? 2. ???????????????????
3. ??????,?????,???????? 4. ??,??????,?????????,??
????,??????????????????,??????????? 5. ???????????
5
???,step3,????????????????????!
6
????
66???,5??????????????,NYHA(New York Heart
Association)???????????????????????,??????????????
??????????. ?????????LVEF 38.
???????ACE??????Renivace 5mg1????. NYHA????? ??
???????,???????????????. ????????,???????????????
. ????????,???????????????.????????,???????????
???????????????.
7
??,???????????ARB(???????????????)?ACE???????????
??????????????????????,??????????????????.???,????
??????????????,???????,CHARM-Added trial(Lancet
2003362767-71)?????????????.
8
?????PECO??
P5????????????66???, NYHA??,LVEF
38,ACE-I??? EACE-I????ARB??? CACE-I???ARB?????
O????????? ??????????
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??3???????????,???????????????????????,??????????
????.
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??3???????
???,?????????????????,?????????????. 1.
??????? 2. ??????? 3. random???????? 4.
ITT,intension-to-treat???????? 5.
????80???????? 6. Baseline???????? 7. ???PECO??
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??,???????????!
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??3???????CHARM-Added
1. ??????????,ACE-I???????????????????????????? 2.
????? 3. random?????? 4. intension-to-treat??????
5. ????2544/2548?99.8?80?????? 6.
Baseline??????
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??3???????CHARM-Added
7. P18????,?????LFEF40??,NYHA??????-?,ACE???????
??30?????????? EACE-I????,????????4 or
8mg????,????32mg CACE-I????,????
O???????????????????????
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GATE???? a Generic Appraisal Tool for
Epidemiology
????
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GATE?????Patients
Source Population
?????????????
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GATE?????Patients
Source Population
Eligible Population
?????????????
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GATE?????Patients
Source Population
Participants
Eligible Population
?????????????
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GATE?????CHARM-Added
1999?3???1999?11????26??618????????
source Population
Participants
Eligible Population
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GATE?????CHARM-Added
source Population
Participants
Eligible Population
18????,?????LFEF40??,NYHA??????-?,ACE?????????30?
?????????
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GATE?????CHARM-Added
??????2548?
source Population
Participants
Eligible Population
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GATE????? Intervention/Comparison
Exposure Grp (intervention)
Participants
Comparison Grp (control)
????????????
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GATE?????CHARM-Added
ARB 4 or 8mg????,???32mg???
??
??
Exposed (intervention)
Participants
Comparison (control)
ACE?????
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GATE????? Intervention/Comparison ????????
EG1
EG2
Participants
EGn
CG
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GATE????? Intervention/Comparison
EG
Participants
????
CG
????????????????????????
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GATE?????outcomes (2??????????????)
Outcomes? -
EG
Participants
CG
????????????????
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GATE?????CAHRM-Added
Outcomes ??????? -
??
??
yes
no
ACE-IARB
Participants
ACE-I
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GATE?????outcomes (????????????????????)
Outcomes? 1 2 3 n
EG
Participants
CG
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GATE?????outcomes (???????????????)
Outcomes? -
EG
high ? low
Participants
CG
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GATE?????time (????)
Outcomes? -
EG
Participants
CG
??? Time
???????????????
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GATE?????time (????)
Outcomes? -
EG
Participants
CG
??? Time
???????????????
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GATE????5 PECOT???????
4.Outcomes -
2. Exposure Gp 3. Comparison Gp
1. Participants
5. Time
??????????????????????????,(4?????)5??????????. ??
??,????????5????????????.
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5 ????

• P 18???,NYHA??????
• LVEFlt40
• E ACE????ARB????
• C ACE?????
• O ????,???,
• ???????????????
• T 41??(3.4?)

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?????????!
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GATE???????
Outcomes -
EG CG
A B
Participants
Time
????
??????
??????
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GATE ???????????
source Population
Outcomes -
EG CG
A B
Participants
Time
??????
eligible Population
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GATE ??????CHARM-Added
1999?3???1999?11????26??618????????
??????2548?
source Population
Participants
Eligible Population
18????,?????LFEF40??,NYHA??????-?,ACE?????????30?
?????????
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????
Outcomes -
EG CG
A B
Time
????
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???? -?????????????????????
Outcomes -
EG CG
A B
??????
??
????
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????-?????????????? ????
A B
EG CG
Time
????
????
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?????? -??????????????????
Outcomes -
Exposure Comparison
A C B D
EG CG
Time
??????
??????
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??????
????????? ????????
Outcomes -
Exposure Comparison
A C B D
EG CG
Time
??????
??????
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??????????????????????????
??????
Exposure Comparison
Outcomes -
A C B D
EG CG
Time
??????
??????
???????????????
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?????? ????????/???????
A B
EG CG
Time
??????
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?????! ?????????
Outcomes -
EG1
EG2
A C B D
???
Participants
CG2
CG1
??????
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GATE

• The numbers
• ??????????.

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??????...

• ???????????? OCCURRENCE?(????????)?????

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OCCURRENCE

• ?????????/??/??
• ??/??/??

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GATE?????the numbers
?? Outcomes -
??
???
Participants
???
TIME
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Occurrence

• Incidence
• ????????????ONSETS(???????????????????????????)
• (??/??)/T
• Prevalence
• ???????????? STATUS(????????????????????)
• Point prevalence????????????
• Period prevalence????????????
• ??/??
• or ? (??)/??average or mean

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Occurrence (Incidence) ??/??/T
??
?? Outcomes -
EG CG
A C B D
Participants
??
TIME
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Occurrence (Prevalence) ??/??
??
?? Outcomes -
EG CG
A C B D
Participants
??
TIME 1
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GATE ????? the numbers
?? Outcomes -
??
EG1
EG2
A B
???
Participants
CG2
CG1
EGO A/EG1 (Intention To Treat ITT??) or EGO
A/EG2 (On Treatment OT??)
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?????

• EGO A/EG1 (Intention To Treat ITT??)
• or EGO A/EG2 (On Treatment OT??)
• ?????Relative risk (RR) EGO
• CGO
• ?????Absolute risk (AR) EGO - CGO
• ?????Number Needed to Treat (NNT)
• 1 / Absolute risk

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GATE?????CHARM-Added
?? Outcomes -
??
EG11276
EG2
???
Participants
CG2
CG1 1272
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GATE?????CHARM-Added
?? Outcomes -
??
EG11276
3
EG2
???
Participants
CG2
1
CG1 1272
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GATE?????CHARM-Added
?? ??????? -
??
EG11276
3
EG2
A483 B538
???
Participants
CG2
1
CG1 1272
Time 41 Mos
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Occurrence??

• EGO 483 events / 1276 on ACE-IARB / 41 Mos
• 11.1 / 100 persons / year
• CGO 538 events /1272 on ACE-I only/ 41 Mos
• 12.4 / 100 persons / year

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?????

• EGO A/EG1 (Intention To Treat ITT??)
• or EGO A/EG2 (On Treatment OT??)
• ?????Relative risk (RR) EGO
• CGO
• ?????Absolute risk (AR) EGO - CGO
• ?????Number Needed to Treat (NNT)
• 1 / Absolute risk

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?????

• ????? (RR) EGO 11.1 0.90
• CGO 12.4
• ?????(AR) EGO - CGO
• 11.1/100/yr - 12.4/100/yr -1.3/100/yr
• ????? (NNT)
• 1 / ARR 1/1.3/100/yr 76

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?????

• EGO11.1ACE-I?ARB??????,1???11.1?????????.
• CGO12.4 ARB????ACE-I?????,1???12.4?????????.
• RR0.9ARB?????1??10???????????.
• NNT76ARB?????76?????1?????????1?????.

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GATE?RCT??????????????????????
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GATE ?????????(????)
???
Outcomes -
EG CG
A C B D
Participants
???????
???
Time
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GATE ???????
??
Outcomes -
EG CG
A C B D
Participants
???????
???
Time
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GATE intervention before/after studies
??
Outcomes -
EG CG
EG CG
A C B D
Participants
???????
??
Time
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GATE ????(??/??/??)
??????????
Outcomes -
EG CG
A C B D
Participants
??
??????????
Time
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GATE ?????
??????????
Outcomes -
EG CG
A C B D
Participants
??
??????????
Time
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GATE ??????????
????
?? -
EG CG
A C B D
Participants
??
????
Time
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GATE ??????????? (????????)
??????????
Outcomes -
EG eg CG cg
A c C B d D
Population
??
??????????
Time
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??????,GATE????,???????1???????????????????.
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???????? ????
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The GATE Frame a Generic Appraisal Tool for
Epidemiology
Rod Jackson Director EPIQ July 2003
http//www.health.auckland.ac.nz/comhealth/epiq/ep
iq.htm
72
???????,2003 How to Teach Evidence Based Medicine
Workshop in Oxford?Prof. Rod Jackson???????????,??
,????,2003?11?8??pES club?TTD?????????.????????Pro
f. Rod Jackson????????This slides are the
translated modified version of which Prof. Rod
Jackson, the director of EPIQ, New Zealand talked
on 2003 How to Teach Evidence Based Medicine
Workshop in Oxford, UK. They used for Tutors
Training Days on November 8th, 2003 by Eishu
Nango, the administrator of the SPELL, at pES
club, the evidence-based journal club. I would
like to thank Prof. Rod Jackson for permitted
translation.
http//www.health.auckland.ac.nz/comhealth/epiq/ep
iq.htm