Evidence-Based Evidence-Based Medicine Medicine

PresentationPresentation[Insert your name here]

[Insert your designation here][Insert your institutional

affiliation here]Department of Obstetrics & GynecologyDepartment of Obstetrics & GynecologyGreenville Hospital System University Greenville Hospital System University Medical CenterMedical CenterGreenville, South CarolinaGreenville, South Carolina

Patient PresentationPatient Presentation

• Details of patient presentation that prompted the clinical question

Clinical QuestionClinical Question

• State the clinical question

BackgroundBackground

• What general knowledge about the clinical topic and or disease is needed PRIOR to searching for evidence to answer your specific clinical question?

• Limit background slides to 2 slides at most

Search StrategySearch Strategy

• List the data sources you utilized• If you conducted a search of an

electronic database, summarize your search strategy

Search ResultsSearch Results

• For each data source, list the types of information that you identified– RCT– Case-control studies– Cohort studies– Case series– Guidelines, expert opinions, review

articles

Evidence AppraisalEvidence Appraisal

• List which of the identified sources were appropriate to your specific clinical question

• Summarize how you determined which of the identified studies were appropriate to use in answering your specific clinical question

• Remember, you are not trying to present ALL of the evidence, just the BEST evidence

Evidence AppraisalEvidence Appraisal

• For each BEST evidence source, perform a critical appraisal, to include some or all of the subsequent slide content

• You must critically evaluate EACH evidence source that you believe helps to answer your clinical question.

HypothesisHypothesis

• If an analytic study, what is the hypothesis that is being tested?

ObjectivesObjectives

• What are the primary and secondary objectives of the study?

Methods: DesignMethods: Design

• What type of study was done? Primary research (experiment, randomized

controlled trial, other controlled clinical trial, cohort study, case control study, cross sectional survey, longitudinal survey, case report, or case series)?

Secondary research (simple overview, systematic review, meta-analysis, decision analysis, guideline development, economic analysis)?

• If a “randomized trial” was randomization truly random?

Methods: SettingMethods: Setting

• What is the setting in which the subjects were studied (e.g. inpatient, outpatient, community hospital, teaching hospital, university)?

• If a clinical investigation, was the study conducted in “real life” circumstances?

Methods: SubjectsMethods: Subjects

• Who is the study about? How were subjects recruited? Who was included in and who was

excluded from the study?

Methods: InterventionsMethods: Interventions

• What intervention or other maneuver was being considered?

Methods: OutcomesMethods: Outcomes

What outcome(s) were measured and how?

• Was assessment of outcome (or, in a case-control study, allocation of cases) “blind”?

Was follow-up complete?

Methods: StatisticsMethods: Statistics

• What sort of data do the authors have?

• What types of statistical tests were used and were they appropriate to the data type?

• Have the data been analyzed according to the original study protocol?

ResultsResults

• Were the groups similar at the start of the trial?

• Aside from the experimental intervention, were the groups treated equally?

• What are the key results?

ConclusionsConclusions

• Do the results support the original study hypothesis?

CommentaryCommentary

• Does the evidence you found help to answer your original clinical question?– Can the results be applied to my patient

case?– Will the results lead directly to

selecting or avoiding therapy?– Are the results useful for reassuring or

counseling patients?

RecommendationRecommendation

• State what specific recommendation that you can make (if any) in regards to your clinical question and list the level of evidence for each recommendation:

– Level I: Evidence obtained from at least one properly designed RCT

– Level II-1: Evidence obtained from well-designed controlled trials without randomization

– Level II-2: Evidence obtained from well-designed cohort or case-control studies analytic studies

– Level II-3: Evidence obtained from multiple time series, with or without the intervention

– Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees

ReferencesReferences