Professional Documents
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Define the clinical question in four parts: Patient, Intervention, Comparison, Outcome (PICO) Show that you have searched for, cited, and summarised studies of appropriate relevance, design, and quality, and should state which bibliographic databases you have used.
Answer the clinical question or state that there is no answer available.
www.bmj.com
Results
Discussion Conclusion
Case
Detailed description
relevant characteristics findings & particularities
Motivation problem
knowledge gap (education, study book, practice) why important?
Research question
Translation clinical bottom-line, follows from description of problem.
Patient Intervention Comparison Outcome
Search; methods
Methods search see course book and practical lecture
Make it transparant! Table 1 with search strategy
Search; results
Table 1: search strategy Source files searched (internet) Combination of search terms (OR, AND) Numbers
Table 1: Search strategy
Database Pubmed Search strategy ((magnetic resonance imaging [MeSH]) AND (mammography) AND (breast neoplasms [MeSH])) AND (specificity[Title/ Abstract]) Limits hits 57 Selected articles 6
Embase Cochrane
(breast cancer) AND (MR) AND (premenopausal) Breast neoplasms AND Magnetic Resonance Imaging
2 19
1 0
Select; methods
Reduction number titles Prior definition of exclusion and inclusion criteria
Select; results
Figure 1: flow chart selection (flow chart) Search results different databases (number) Clear exclusion criteria Numbers not selected (per exclusion criterium) Number articles, selected for further assessment (critical appraisal).
A N D PubMed
A N D
Mortality
Embase 51
Exclusion criteria: -Animals -Neonates -Adults -Therapeutic study -CSF composition not specified Inclusion criteria: -Prognostic study -Mortality as outcome -CSF composition as prognostic factor Excluded because of: -Insufficient outcome (mortality) -Experimental, noncomparable CSF measurement -Therapeutic study
79 Screening title abstract* 18 Filtering doubles 27 Screening title abstract* 18 Full text availability 13 Reading full text*
13
1 article found by screening references Useful: 10 articles Not useful (domain: adults also included)
Search date: 30 November 2005 *All decisions were made by consensus or at least 2 authors
Relevance for patient (patient included?) Patient, Intervention, Comparison, Outcome Search similarities & differences
: random? consecutive? : randomization? inception cohort? : masking? similar treatment? drop out? : blinded? objective?
Specific for patients case Own simply applied system Never forget legends
Similarity determinant
Determinant
Outcome Type of study
As in practice
As in practice
Manipulated
Mortality, morbidity, QoL Follow up (time until outcome) Causal RR/RD
reference test or - Mortality, morbidity, criterium QoL Cross sectional Follow up (time until outcome) Descriptive AR
Descriptive AR
Discussion
Interpretation results best available evidence Formulation recommendation patient Explicit motivation recommendation Considerations concerning relevance (restrictions?) validity (restrictions?)
EBCR- Summary
Case Clinical question Search strategy
Text Introduction, clinical question Justification: management problem Flow chart Sources, selection, numbers
Tables Relevance & validity Strength of evidence Text Interpretation of the results Recommendations for management Comments
Advantages
Learn to apply evidence-based practice Fill the knowledge gap
Disadvantages
Detailed / minute-to-minute management might be lacking Background knowledge might also be lacking
Questions ?