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SYSTEMATIC REVIEW (OF THERAPY) WORKSHEETCitation:Are the results of this systematic review valid?

Is this a systematic review of randomisedtrials?Does it include a methods section thatdescribes:a)finding and including all relevant trials? b)assessing their individual validity?Were the results consistent from study tostudy?Were the individual patient data used in theanalysis (or aggregate data)?

Are the valid results of this systematic review important?Translating odds ratios to NNTs:

The numbers in the body of the tables are the NNTs for the corresponding odds ratio atthat particular patient’s expected event rate (PEER).

1.When the odds ratio (OR) < 1

This table applies when a bad outcome is prevented by therapy.OR < 10.90.80.70.60.5Patient’sexpectedevent rate(PEER)0.05

2.09

104695241

0.10

11054362721

0.20

6130201411

0.30

462214108

0.40

40191297

0.50

38181186

0.70

44201396

0.90

101

46271812

The relative risk reduction (RRR) here is 10%

The RRR here is 49%

For any OR, NNT is lowest when PEER = 0.50

The RRR here is 9%

2.When the odds ratio (OR) > 1

This table applies both when a good outcome is increased by therapy and when aside-effect is caused by therapy.OR > 11.11.21.31.41.5Patient’sexpectedevent rate(PEER)0.05

212106715443

0.10

11257382923

0.20

6433221714

0.30

4925171311

0.40

4323161210

0.50

4222151210

0.70

5127191513

0.90

12166473832

Can you apply this valid, important evidence from a systematic review in caring foryour patient?

Do these results apply to our patient?Is your patient so different from those inthe study that its results cannot apply?Is the treatment feasible in your setting?What are your patient’s potential benefits and harms from the therapy?

Method I:

In the OR tables above, find theintersection of the closest odds ratio fromthe systematic review and your patient’sexpected event rate (PEER)

Method II:

To calculate the NNT from anyOR and PEER:

( ){ }

)1()1( 11

OR PEER PEEROR PEER NNT

−××− −×−=

Are your patient’s values and preferences satisfied by the regimen and its consequences?Do you and you patient have a clear assessment of their values and preferences?Are they met by this regimen and itsconsequences?