EBM presentation review
General definitions
Term
Randomized Controlled Trial
Systematic review
Meta analysis
Critical Appraisal
Risk of Bias
p-value
Definition
a clinical trial in which participants are randomly
allocated to a test treatment and a control involves
concurrent enrolment and follow up of both groups gold
standard in testing the efficacy of an intervention
(therapy/prevention)
Identifies and critically appraises all research on a
specific topic, and combines valid studies to limit bias
in the identification, evaluation and synthesis of the
relevant studies that address a specific question
a statistical technique that uses quantitative methods to
summarise the results.
The process of carefully and
systematically examining research to
judge ( its trustworthiness, and its value and relevance
in a particular context)
Is important in:
 Combating information overload
 Identifying clinically relevant papers
 Continuing professional development
The degree to which the result is skewed away from the
truth
Measure of probability that a result is due to chance;
The smaller the value (usually P
<=0.05 ) less likely (e.g. p=0.0001 the results are very
unlikely to be
due to chance.
A p value >0.05 is likely to be due to chance.
 95% Confidence interval 95% of the time that you construct a 95% CI, the mean
of the population (µ) will be in
that interval.

5% of the time that you construct a 95% CI, you are

going to get a sample that does not include the
population mean.

 Width of CI indicates amount of variability

o Narrow range: Large sample size; more
reliable and greater precision
o Wide range: Small sample size; less
reliable and lower precision
 Statistical significance:
o Difference in means- 0 outside interval
o Odds ratio and RR- 1 outside interval
Sampling error Different samples from the same population → obtain
different results.

Statistically significant The difference observed would have been unlikely to

have occurred by chance (conventionally on 5 of
occasions) =Effect not explained by chance (p<0.05)

Clinically Significant: Means that the difference observed is of sufficient

magnitude to be apparent and important in a clinical
setting.
= effect is clinically important

Odds Ratio is a measure of association between an exposure and an

outcome

Relative Risk (RR) is the ratio of the risk of occurrence of a disease among
exposed people to that among the non-exposed

Absolute Risk Reduction (ARR) refers to the decrease of a bad event as a result of the
intervention.

Relative Risk Reduction Reduction in rate of outcome in treatment group

relative to control group
RRR= (1- RR)

An Absolute Benefit Increase refers to the increase of a good event as a result of the
(ABI) intervention.

 PICO tool
Aim of PICO: a useful tool to formulate a precise clinical question by cutting apart and
identifying the four components to facilitate the search

PICO PICO Components Search Strategy

Patient/Problem/Population 50-year-old woman, Asthma attacks 
Asthma
Intervention Vitamin D  Vitamin D
Comparison Placebo
Outcome Reduce asthma attacks

Forest plots

Key features

Middle line Line of no effect

Horizontal line at bottom Measurement of treatment effect

Red squares Size correlates to weight of study

Horizontal lines across squares CIs *containing 1 is not significant

Diamond Pooled analysis; horizontal width is 95% CI

*width of diamond crossing line of no

effect-> no statistically significant different
in effects of 2 interventions

p-value in heterogeneity <0.05 indicates heterogeneity present

*can also use eyeball test to check

heterogeneity, but in a shitty way

I2 Variability between studies (higher-> more

variable)
 0.0%- indicates homogenous studies

Rate ratio ratio of the incidence in an exposed group

divided by the incidence rate in an
unexposed (or less exposed) comparison
group.

Forest plot 1: Vit D vs placebo measuring exacerbations requiring systemic corticosteroids.

Key features

Significance of CIs of all studies 2/3 (Jensen, Martineau) not statistically

significant- include 1 in interval

Castro- statistically significant

Diamond Favours Vit D compared to placebo

Rate ratio 0.64; indicates Vit D treatment reduced rate

of exacerbations requiring systemic
corticosteroids by 36%

p-value in heterogeneity 0.75>0.05, indicates heterogeneity not

present

I2 0.0%- indicates homogenous studies

 Forest plot 2: Vit D vs placebo measuring people with one or more exacerbations requiring
ED visit or hospitalisation or both.

Key features
 Significance of CIs of all studies 6/7 (Jensen, Majak 2009 and 2011,
Martineau, Tachimoto and Urashima) not
statistically significant- include 1 in interval

1/7 (Castro), - statistically significant

Diamond Favours Vit D compared to placebo

Odds ratio 0.39; indicates Vit D treatment reduced

exacerbations requiring ED/ hospitalisation
by 61%

p-value in heterogeneity 0.65>0.05, indicates heterogeneity not

present

I2 0.0%- indicates homogenous studies

 
Forest plot 3: Vit D vs placebo measuring people with one or more study defined
exacerbations

Key features

Significance of CIs of all studies 4/7 (Castro, Jensen, Martineau, Tachimoto) not
statistically significant- include 1 in interval

3/7 (Majak 2011, Urashima, Yadav), - statistically

significant

Diamond Favours Vit D compared to placebo

Odds ratio 0.53; indicates Vit D treatment reduced study defined

exacerbations by 47%

p-value in heterogeneity 0.009<0.05, indicates heterogeneity present

I2 65%- indicates moderate to substantial heterogeneity