ebp-harm for PCMC evidence based pediatrics

8/13/2019 ebp-harm for PCMC evidence based pediatrics

http://slidepdf.com/reader/full/ebp-harm-for-pcmc-evidence-based-pediatrics 1/92

BASIC STEPS IN JOURNAL SEARCH & REVI. Clinical Question (PICO)

P - PopulationI - InterventionC - Standard of CareO - Outcome

II. Comparator

Standard of CareDiagnosticsTherapeuticsNone for harm & prognosis

III. Baseline Variable

Standard of CarePretest Probability for DiagnosisTherapeuticsPrognosisHarm

IV. Intervention - Will it be better?DiagnosticsTherapeutics

V. Literature Search



DATABASELIMITSHIERARCHY

Meta-analysisRCTCohortCross-section

Case ControlCase SeriesCase ReportExpert Opinion

Evaluate Directness (PICO)

VI. Test for ValidityVII. Result if Valid

Diagnosis: LRs, Sn, Sp, p-valueTherapy: Dichotomous or continuou

Point Estimates,RR, ARR, NNT,

Look for another if not validVIII. Applicability

Diagnosis: post test using Fagan's Ncompare post and pretest prob



Therapeuticscurrent risk using result of the scurrent risk and baseline risk

IX. Biological issuesAvailabilityCost and Feasibility



IEW



s-value, interval estimate, p-value, level

rmogrambility



tudy



f significance



WORKSHEET - HARM1. Clinical Question: Among 0 what is the

a. Populationb. Interventionc. Standard

d. Outcome

2. Article Search:Database: x www.pubmed.com

www.cochrane.orghttp://jama.jamanetwork.com/journ

Keywords:Article (pdf or html): http://www.ncbi.nlm.nih.gov/pubme

http://www.ncbi.nlm.nih.gov/pmc/a3. Appraising Validity

1. Were the patient groups being comopared sufficiently similar wit

2. Were unbiased criteria used to determine exposure in all patient

http://www.pubmed.com/

http://www.cochrane.org/

http://jama.jamanetwork.com/journal.aspx

http://www.ncbi.nlm.nih.gov/pubmed/20195633

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890074/pdf/431_2010_Article_1160.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890074/pdf/431_2010_Article_1160.pdf

http://www.ncbi.nlm.nih.gov/pubmed/20195633

http://jama.jamanetwork.com/journal.aspx

http://www.cochrane.org/

http://www.pubmed.com/



2. Were unbiased criteria used to detect the outcome in all patients3. Was the follow-up rate adequate?

4. Apprasing Results1. How strong is the association between exposure and outcome?A. RCTS and Cohorts

Outcome No OutcomeExposed a b

RECRUITMENT Unexposed c d

Relative Risk (RR) a/ (a+b) / c/(c+d) = 1a = 1 a+b = 2b = 1 c+d = 2c = 1 a / (a+b) = 0.5d = 1 c / (c+d) = 0.5

B. Case-control Studies

RECRUITMENTOutcome No Outcome

Exposed a bUnexposed c d



RESULT

Odds Ratio (OR) (a/c) / (b/d) = 1a = 1 a/c = 1b = 1 b/d = 1c = 1d = 1

2. How precise is the estimate of the risk? OR = valuePresented as confidence interval = % sure that the tr

5. Assessing Applicability1. Sex2. Co-morbidities

3. Race4. Race5. Age6. Pathology7. Socioeconomic factors

6. Individualizing the result



6. Answer



(PCMC@2013)0.00 of 0.00 in comparison wit 0.00

Directness of the Study (Article from Step 2)

http://www.pchrd.dost.gov.ph/http://www.thelancet.com/

l.aspx

d/20195633ticles/PMC2890074/pdf/431_2010_Article_1160.pdf

h respect to baseline characteristics YES NO

s?YES NO

http://www.pchrd.dost.gov.ph/

http://www.thelancet.com/

http://www.thelancet.com/

http://www.pchrd.dost.gov.ph/



? (blinding)

RESULT

( RR > 1 suggest harm)

(exposed)(unexposed)



(OR > 1 suggests harm)(outcome)(no outcome)

[ % CI:lowest limit, upper limit] i.e. OR=14[95% CI:3.3,59.3]e strength of association (the odds ratio lies within the range)



Research Question Answer Searched Article



Appraisal Appraised by Date



Research Question Answer Searched Article Appraisal



Research Question Answer



Searched Article Appraisal Appraised by Date



Research Question Answer



Searched Article Appraisal Appraised by Date



AVENGERSSearched Articles Appraised Journals Score

Acero, AngelynCarreos, Ma ElarnieInoncillo, MilletteMillora, HasminPrabowo, JohanesSy, RomelynAlonzo, DianaCabaltera, TwinkleConti, Mary AngeliDe Lara, Katrine AnneMoreno, Leah Grace

Pua, JerryTee, PhoebeAguilera, ChrysBernardus, AndrewCue, Monna LisaGo, Camille-MarieImperial, MeladyMagalit, ShantaR i J

ebp-harm for PCMC evidence based pediatrics

Documents

Transcript of ebp-harm for PCMC evidence based pediatrics