34901-34903

Evidence-Based Medicine(EBM) 1. QUESTION 2.SEARCH 3.APPRAISE 4.PRACTICE 5.AUDIT

Where is the Evidence?Cohort StudyMulti-center StudyClinical Research and/or Studies in Medline:Clinical TrialsClinical Trials Phase IClinical Trials Phase IIClinical Trials Phase IIIClinical Trials Phase IVRandomized Controlled Trials

Animal researchIn vitro(Test tube) researchCase ReportsIdeas, Editorials, OpinionsCase Control StudiesCohort studiesRandomized Controlled Double Blind Studies Meta - analysisRandomized Controlled Studies

- 1 randomized controlled trials 2systematic review

-

-

Grade of recommendation

Level of evidence

Interventions

A

1a

Systematic review of randomized controlled trials

1b

Individual randomized controlled trial

B

2a

Systematic review of cohort studies

2b

Individual cohort study

3a

Systematic review of case-control studies

3b

Individual case-control study

C

4

Case series

D

5

Expert opinion without explicit critical appraisal or based on physiology or bench research

-

Sheet1

LevelTherapy

1aSystematic review()

1b

1cAll or none

2aSystematic review()

2bCohort study

2c"Outcome" Research; Ecological studies

3aSystematic review(-)

3b- Case-control syudy

4-

5

Sheet2

Sheet3

(Case Reports )

-Case Reports(halothane)?

Recurrent hepatitis attributable to halothane sensitization in an anesthetist. N Engl J Med 1969; 280:515-522.

,(Case Series, Case Analysis )(10)p

-Case Series laryngeal cancer19817199161061556%615179246271182425824503582%73%73%67%64%54%35100%91%95%85%88%82%72%61%3594%93%86%71%52%42%25%0%10,, 1994; 295: 376-383

(Case-control study)

Retrospective, ,

- Case-control study

(Cohort study)

ProspectiveretrospectiveBoth are longitudinal!

- Cohort study

(Intervention study)

(Clinical Trial)

(Clinical Trial)Inclusion criteria ()Exclusion criteria () randomized assignSingle blind () Double blind () Triple blind ( )

- Randomized Controlled Clinical Trial()()

(Meta-Analysis):

-1(all studies)?() (P)

-2(cohort studies)

-3(randomized trials)()

-4 (case-control studies)

-5 (Meta-analysis)()()()

CoChrane Collaboration1972Archie Cochrane(Randomized controlled trials;RCT)1992Archie Cochrane1993Cochrane Collaboration http://www.cochrane.org

Archie CochraneIt is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomised controlled trials.

THE COCHRANECOLLABORATION

Cochrane Organization- Collaborative Review Groups Methods Groups Field/Networks Consumer Network Centers Steering Group

EBM- ReviewArticle Review-Database of Abstract of Review Effectiveness

Topic Review-Cochrance Database of Systematic Review

What is Article Review????

Article ReviewBest Evidence

ObjectiveDesignSettingPatientsInterventionMain OutcomeMain ResultsConclusion

Article Review ProcessMonthly Reviewof Top ClinicalJournalsQualityScreeningArticle Review :Enhanced Abstract

Core Journals for Article ReviewAmerican Journal of MedicineAnnals of Internal MedicineArchives of Internal MedicineJournal of Internal MedicineNew England Journal of MedicineDiabetes CareCirculation, JAMA, Lancet

Outline of a Article ReviewAbstract:QuestionDesignSettingPatientsInterventionMain Outcome MeasureMain ResultsConclusions

Commentary:

Reference

Footnotes

What is Systematic Reviews????Topic Review?(CDSR)

Topic ReviewRCTCochrnae Database of Systematic Reviews(CDSR)

Systematic Review ProcessComprehensiveTopic SearchQualityScreeningMeta AnalysisTopic Review

Review Groups HIV/AIDSHypertensionIncontinence Infectious diseasesInflammatory bowel diseaseInjuriesLung cancerMenstrual disorders and subfertilityMetabolic and endocrine disordersMovement disordersMultiple sclerosisMuskuloskeletal Musculoskeletal injuriesNeonatalNeuromuscular diseaseOral healthPain, palliative and supportive carePeripheral vascular diseasesPregnancy and childbirthProstatic diseases and urologic cancersRenalSchizophrenia

200450Review Groups

Cochrane LibraryUpToDateClinical EvidencePubMed-Clinical QueriesMedline-Publication Types

Cochrane Library Cochrane Reviews Cochrane Database of Systematic Reviews DARE Database of Abstracts of Reviews of Effects CENTRAL Cochrane Central Register of Controlled Trials Methodology Reviews CMR--The Cochrane Methodology Register HTA The Health Technology Assessment Database NHS EED The NHS Economic Evaluation Database About Topics

Cochrane Reviews-- Cochrane Database of Systematic Reviews Systematic Reviews of Topic Areas CDSR 49 RCT

DAREDatabase of Abstracts of Review of Effects -4100-Nathonal Health Service Centre for Reviews and Dissemination (NHS CRD)- Systematic reviews- CDSR.

CENTRALCochrane Central Register of Controlled Trials - 40 / - Cochrane - MedlineCinahl -

Cochrane Database of Methodology Reviews (Methodology Reviews)- - - .- Cochrane Methodology Register (CMR) - - - - MEDLINE - systematic review

Health Technology AssessmentDatabase (HTA) - ()NHS Economic Evaluation Database (NHS EED) - - -

AboutThe Cochrane Collaboration and the Cochrane Collaborative Review Groups - /Topics - Cochrane review groups

Search

Search The cochrane library:

EX: Cochrane Reviews

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Results- The cochrane library

Results- The cochrane libraryReviews / Protocols

Results- The cochrane library

Results- The cochrane library A full Review A Protocol (Review) /(Review) (Review/Protocal)

Results- The cochrane libraryExporting Citations

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American Academy of Family PhysiciansTopic Review6,0003000

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Clinical Evidence

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Haynes RB(Therapy)(Diagnosis)(Etiology)(Prognosis)(sensitivity)(specificity)

Medline-Publication Types LimitPublication types hierarchy systematic reviewrandomized controlled trials(RCT)controlled trialsMedlineLimitpublication typesmeta-analysisrandomized controlled trials(Ctrl+Enter)

Publication Types

-

National Guideline Clearinghouse (NGC)PDA

http://www.guideline.gov

1994OxfordRAM and HJM1995

http://www.jr2.ox.ac.uk/bandolier/ Bandolier

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