Course Structure

Evidence Based Medicine, what is it?
What is Critical Appraisal?
How to find papers to answer your question?
How a paper is structured
Different forms of research
Different terminology used to describe research designs
Different categories of evidence
Hierarchy of evidence
Further terminology to be aware of
Statistical methods
Being Aware of Outcomes
Diagnostic studies
Terminology to be aware of in a diagnostic paper
Likelihood ratios and area under the curve
Critical Appraisal of a Diagnostic Study
Therapeutic studies
Treatment effect
Critical Appraisal of a Therapeutic Study
Final Quiz
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Course Structure

Evidence Based Medicine, what is it?

  • An introduction to EBM
  • Examples of great evidence changing practice
  • Examples of poor evidence changing practice

What is Critical Appraisal?

  • PICO
  • Internal validity
  • External Validity
  • Clinical significance

How to find papers to answer your question?

  • MEDLINE, EMBASE, CINAHL etc
  • Grey literature

How a paper is structured

  • Authors
  • Abstract
  • Introduction
  • Methods
  • Results
  • Discussion

Different forms of research

  • Observational descriptive research
  • Observational analytical research
  • Experimental research
  • Qualitative research

Different terminology used to describe research designs

  • Cross sectional
  • Longitudinal
  • Retrospective
  • Prospective
  • Qualitative data
  • Quantitative data

Different categories of evidence

  • Expert opinion
  • Case report
  • Case series
  • Case control
  • Prospective Cohort Study
  • Retrospective Cohort Study
  • Controlled trials
  • Randomised control trials
  • Systematic Reviews
  • Meta-analyses

Hierarchy of evidence

  • Oxford levels of evidence

Further terminology to be aware of

  • Chance
  • Bias
  • Confounding
  • Internal validity
  • External validity
  • Homogeneous
  • Heterogeneous

Statistical methods

  • Accuracy
  • Precision
  • Prevalence
  • Incidence
  • The hypothesis
  • P-values
  • Confidence intervals
  • False positives
  • False negatives
  • Power calculations

Being Aware of Outcomes

  • Statistically significant vs clinically significant
  • Being aware of secondary outcom

Diagnostic studies

  • The gold standard/reference standard
  • The population tested
  • Inter-observer reliability
  • Cost of the diagnostic test

Terminology to be aware of in a diagnostic paper

  • Case positive
  • Case negative
  • Test positive
  • Test negative
  • True positive
  • True negative
  • False positive
  • False negative
  • Sensitivity
  • Specificity
  • Positive predictive value
  • Negative predictive value

Likelihood ratios & area under the curve

  • Positive and negative likelihood ratios
  • Fagan’s nomogram
  • Categorical Likelihood ratios
  • Area under the curve

Critical Appraisal of a Diagnostic Study

  • The gold standard/reference standard
  • The population tested
  • Inter-observer reliability
  • Cost of the diagnostic test

Therapeutic studies

  • Randomisation
  • Allocation concealment
  • Blinding
  • Intention to treat & per-protocol analysis
  • Follow up
  • The outcome of interest
  • Composite outcomes

Treatment effect

  • Relative risk reduction (RRR)
  • Absolute risk reduction (ARR)
  • NNT

Critical Appraisal of a Therapeutic Study

Pull all the theory together and critically appraise a therapeutic study

Final Quiz

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