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Validity
Precision
Aplicability
UPEP FK UNSRI
What is EBM?
UPEP FK UNSRI
UPEP FK UNSRI
UPEP FK UNSRI
Why EBM?
UPEP FK UNSRI
How to do an appraisal ?
By asking questions:
Is it Valid ?
Is it Important ?
Is it Aplicable ?
UPEP FK UNSRI
PROGNOSTIC STUDY
UPEP FK UNSRI
Valid ?
1. Was a defined, representative sample of patients assembled at a common
UPEP FK UNSRI
Valid ?
2. Was patient follow-up sufficiently long
and complete ?
Ideally : every patient in the inception cohort would be followed
until they fully recover or develop one of the other disease
outcomes
Study prognosis 100 patients, 4 die, 16 lost to follow up
A Crude case-fatality rate 4,8 % (4/84 x100%)
UPEP FK UNSRI
Valid ?
3. Were objective outcome criteria applied
in a blind fashion ?
Diseases affect patients; some are easy to spot and some are
more subtle.
Extreme outcomes ; death or full recovery. (easy to detect)
More difficult between them; rediness to work, intensity of
residual paint.
UPEP FK UNSRI
Valid ?
4. If sub groups with different prognosis are
identified:
- Was there adjustment for important
prognostic factors?
- Was there validation in an independent
group of test-set patients?
UPEP FK UNSRI
UPEP FK UNSRI
Important ?
UPEP FK UNSRI
UPEP FK UNSRI
Diagnosis
Was the test compared blindly with a gold standard?
Was there an adequate spectrum of disease?
Was the referral pattern described?
Was the description of the tests clear enough to
reproduce it?
Was the test reproducible (observer agreement)?
Was contribution of the tests to overall diagnosis
assessed?
UPEP FK UNSRI
Therapy
Was the assignment really randomized?
Were clinically important outcomes assesses
objectively?
Was the treatment feasible to your practice?
Were their at least 80% follow up of subjects
Were both statistical and clinical significant
considered?
If the study was negative the power assessed?
UPEP FK UNSRI
ETIOLOGY
Was the type of study strong? (RCT>Cohort>casecontrol>cross-sectional)
Was the assessment of exposure and outcome free of
bias (blinded assessors)?
Were both association statistically and clinically
significant?
Was the association consistent across studies?
Was cause shown to precede the effect?
Was there a dose response relationship?
UPEP FK UNSRI
Evidence-Based Guidelines
Effectiveness of Clinical Intervention
Level Type of evidence
Ia
Ib
IIa
IIb
III
IV
V
UPEP FK UNSRI
Nature of Recommendation
Ia + Ib / ( > I )
Ia / Ib
IIa / IIb
III
IV / V
UPEP FK UNSRI