Upload
paulafunnell
View
238
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Session 4, workshop 3
Citation preview
Paula [email protected]
Senior Academic Liaison Librarian (Medicine and Dentistry)
Guide to
Evaluating the Evidence
Why?
To weigh up how valid and useful
the research will be
Why? – to save time
• In order to keep up to date, clinicians would have to read 17 articles a day, 365 days a year
• Research is of variable quality• Only an estimated 1% is
judged clinically relevant• Need to find the 1%
Publication bias
Papers with “interesting” results are more likely to be:
• Submitted and accepted for publication• Published in a major journal • Published in English• Quoted by authors• Quoted in newspapers
Brainstorm
What factors should you be bearing in mind when reading an article?
Think about• the research described• how it is reported
RCT checklist
How are the results presented?
• Number needed to treat (NNT)• Odds Ratio• Relative risk• Mean difference
Odds and risk
Odds of winning
1:9
You versus the rest
Risk of winning
1:10
You versus all the runners
10 horses running, you bet on 1 horse
Forest plots
more than 1less than 1 1
Forest plots
more than 1less than 1 1
Line of no effect
Forest plots
more than 1less than 1 1
Line of no effect
Forest plots
more than 1less than 1 1
Line of no effect
Best estimate
Forest plots
more than 1less than 1 1
Line of no effect
Best estimate
Confidence interval
Forest plots
more than 1less than 1 1
Line of no effect
Best estimate
Confidence interval
Forest plots
more than 1less than 1 1
Line of no effect
Best estimate
Confidence interval
Pooled result
P-value
Could the result have occurred by chance?
p = 0.001 (1 in 1000)
p = 0.2 (1 in 5)
A p-value of less than 0.05 (1 in 20) is considered to be statistically significant
How it works
• Involves answering a short questionnaire• We use the CASP questionnaires at
http://www.sph.nhs.uk/what-we-do/public-health-workforce/resources/critical-appraisals-skills-programme
• The questionnaires were devised by doctors for doctors
Summary
Validity
Is it trustworthy?
Results
What does it say?
Relevance
Will it help?
Group critical appraisal
1) Did the review address a clearly-focused question?
Group critical appraisal
2) Did the authors look for the appropriate sort of papers?
Group critical appraisal
Is it worth continuing?
Group critical appraisal
3) Do you think the important, relevant studies were included?
Group critical appraisal
4) Did the reviewers do enough to assess the quality of the included studies?
Group critical appraisal
5) If the results of the studies have been combined, was it reasonable to do so?
Group critical appraisal
6) What are the overall result of the reviews?
Group critical appraisal
7) How precise are these results?
Group critical appraisal
8) Can the results be applied to the local population?
Group critical appraisal
9) Were all important outcomes considered?
Group critical appraisal
10) Are the benefits worth the harms and costs?