Critical Appraisal of Evidence

Lexicomp Clinical Key MicroMed PubMed

4 tools we can use to help in searching for the best evidence

retrospective one

A case report/study/series is considered _____ (looking back) and only focuses on _____ patient.

all of the above

A test can be: A. reliable B. valid C. both D. one of them E. neither of them F. all of the above

consistent results (doesn't have to be the same for everyone but should be consistent)

A test is reliable when it yields _____.

it measures what it's supposed to

A test is valid when _____

(PICO) Patient Intervention Comparative Outcome

A tool that we can use within the first step of the EBP

(1) Can help in the identification of new trends or diseases (2) Can help detect new drug side effects and potential uses (adverse or beneficial) (3) Educational - a way of sharing lessons learned (4) Identifies rare manifestations of a disease

Advantages:

Case (study) report

An article that describes and interprets an individual case, often written in the form of a detail story

Epidemiology

Both the principle and methods of _____ are used frequently to help us in evaluating evidence that is pertinent to health care decisions.

(1) First line of evidence (2) Illustrate an important variation of a disease or condition (3) Illustrate where one patient has two or more unexpected diseases or disorders (4) Generate hypothesis (5) Allocate resources and plan programs

Clinical use of Case Study/Case Series:

17

Clinicians have to read ___ peer review articles a day in order to stay current.

Critique

Critical appraisal is _____. It is not blaming fault or to say something is wrong.

(1) Patient should be described in detail, allowing others to identify patients with similar characteristics (2) Case reports/case series should include carefully recorded, unbiased observations (3) Case reports/cases series should explore and infer, not confirm, deduce, or prove

Design Pitfalls to look out for:

(1) Can be initially time consuming when we don't know what we're looking for (2) Doesn't provide an easy answer (3) Can show there is a lack of good evidence for a particular topic

Difficulties with critical appraisal:

(1) Cases may not be generalizable (2) Causes or associations may have other explanations (3) Can be seen as emphasizing the bizarre or focusing on misleading elements

Disadvantages:

Observational studies

Epidemiologic studies are also called _____.

(1) the arrows are consistent so its reliable, doesn't hit the center so not valid (2,3) the arrows are not consistent so not reliable, doesn't hit the center so not valid (4) the arrows are consistent and hitting the center so its reliable and valid

Explain:

Purpose

How valid a test is depends on its _____.

(1) Are the results valid? (2) What are the results? (3) How will these results be relevant to the patient?

Key steps to effective critical appraisal:

(1) randomized controlled trial and meta-analysis (2) nonrandomized trials, concurred and historical controls (3) cohort study, prospective and retrospective (4) case-control study (5) cross-sectional study (6) case study (7) case report

Levels of Quantitative Evidence (hierarchy - list from the top):

Qualitative

Research method that is useful for finding detailed information about people's perception and attitudes

Quantitative

Research method that is useful for finding precise answers to defined questions

Quantitative

Research method that uses numbers to describe and analyze

Qualitative

Research method that uses words to describe and analyze

Validity

Step of critical appraisal where we ask ourselves if the information is trustworthy (did the researchers do what they said they did, did they follow protocol)

Relevance

Step of critical appraisal where we decide how useful the research will be to our focused question or how useful the information ill be to the patient

Results

Step of critical appraisal where we figure out what the literature is telling us and if the researchers were able to reach the outcome

Epidemiologists

These people look to what type of evidence they can find from the population to help us with our public health disasters (could also include the environment of their study)

Quantitative and Qualitative

Two types of research methods:

Surveys

Types of study designs used in qualitative research methods:

(1) Clinical trials (2) Systematic reviews (review of # of randomized trials)

Types of study designs used in quantitative research methods:

Hypotheses

We find out the purpose of a test by looking at the _____.

information masters

We need evidence based practice to become ___.

Best evidence (clinical trials, systematic research) Patient values (religious and moral beliefs, preferences and rights) Clinical experience (professional judgment, experience)

What are the 3 components of evidence based practice (EBP)?

(1) Question (2) Evidence (3) Critical Appraisal (4) Application (5) Implementation and monitoring * Quails Eat Crunchy Apples Indefinitely on Mondays

What are the 5 steps of evidence based practice?

(1) Question

What step of the EBP process is used to formulate a focused question?

(1) Published research is not always reliable (2) published research is not always relevant (3) To improve clinical effectiveness, we need a systematic frame work interpret research

Why should we critically appraise?

Reliability

_____ is a prerequisite for measurement validity.

Epidemiology

study of factors that affect health and disease particularly from a population or public health perspective