Beruflich Dokumente
Kultur Dokumente
Therapy
‘Evidence-Based Medicine’
‘Critical Appraisal’
Research Methodology
“Evidence-Based Medicine”
(Papers in Journal of Medicine / Health Sciences)
‘VIA’
‘Valid’ Methodology of study
‘Applicability’ Discussion
Treatment / Therapeutic intervention
Comparison : Diuretics
Outcome : prevent heart disease;
stroke; end-organ damage?
“EBM” for therapy
Systematic review :
* in gathering, evaluating, presenting evidence
* no formal statistical method
Meta-analysis :
* systematic review + formal statistical analysis
Integrative literature
Review article
Systematic review
Meta-analysis
1. Reports of individual studies
Randomization
Control Blinding
Reports of individual studies
• Preventing bias
• Equal chance
• Balance of subjects characteristic
Toast / coin
Simple randomization (random table)
Block randomization
Stratified randomization
2. Was follow-up of patients sufficiently long
and complete?
Secondary guides:
1. Were patients, health workers,
and study personnel "blind" to treatment?
Single
blind
Double
blind
Triple blind
Prevent bias
‘Blind’ intervention
Similar:
Form
Color
Taste
Drug of
administration
1. 2. Are the valid results of individual
study,
important?
1. 2. 1. What is magnitude
of the treatment
effect?
1 Hospitalized
27
26 Non-Hospitalized
N = 54 R
7 Hospitalized
27
20 Non-Hospitalized
budesonide
normal saline
Important
Upper-airway obstruction
No Yes
Budesonide (E) 26 1 27
NaCl (C) 20 7 27
X2 df =1 p = 0.04
Important
Upper-airway obstruction
No Yes
Budesonide (E) 26 1 27
NaCl (C) 20 7 27
In the hypothetical
0.00026 0.00004 0.00022 5000
trivial case
1. 2. 2. Elements for deciding precision
of the treatment effect
Confidence
interval
(<< CI precission of the treatment effect)
1. 3. Are the valid, important results of this
individual studies applicable to our patient?
25 % of the
Example: control group
To express (X) died
results 20 % of the
in a study treatment group
where (Y)
Absolute Risk Reduction X-Y =
(ARR or risk difference) 0.25 – 0.20 = 0.05
RRR
RRR==(CER-EER
(CER-EER// CER)
CER) (50%
(50% -- 39%)
39%) // 50%
50% == 22%
22%
ARR
ARR== (CER-EER)
(CER-EER) 50%
50%-- 39%
39% == 11
11%
%
NNT
NNT== (1
(1//ARR)
ARR) 11// 11%
11% == 99
NNT
NNT 10
10 month
month =
= 99 xx (33
(33 // 10)
10)
=
= 29.7
29.7
Table 5.4 EBM-Sacket
TRIMA KASIH