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Evidence into Practice: how to read a paper Rob Sneyd (with help from...Andrew F. Smith, Lancaster, UK)

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Evidence into Practice: how to read a paper Rob Sneyd (with help from...Andrew F. Smith, Lancaster, UK) Slide 2 Outline Evidence-based medicine Appraisal of published trials The anatomy of a journal Slide 3 Four steps to evidence-based practice 1.Ask a clinical question 2.Search for evidence 3.Critically appraise the evidence 4.Integrate the evidence into practice Slide 4 Levels of evidence ISystematic review of RCTs IISingle RCT III Cohort studies IVCase series VSingle case report Slide 5 Appraisal of published studies Slide 6 Is this paper any good? 1.Validity 2.Applicability 3.Logical flow Slide 7 Validity: bias and distortion Slide 8 Bias in clinical trials Recruitment Selection Allocation Performance Observer Inference Reviewer Slide 9 Bias in clinical trials Recruitment Selection Allocation Randomisation PerformanceBlinding ObserverBlinding Inference Reviewer Slide 10 Introduction Slide 11 Method Introduction Slide 12 Method Meaningful outcomes Inclusion and exclusion Detail - replicability Measurement tools Allocation concealment Blinding and control groups Follow-up and dropouts Power calculation and significance Slide 13 Method Results Introduction Slide 14 Method Discussion Results Introduction Slide 15 Discussion Summary of main findings Comment on strengths and weaknesses Comparison with other studies similarities and differences Mechanisms and implications Unanswered questions and future work Slide 16 Method Conclusion Discussion Results Introduction Slide 17 Method Conclusion Discussion Results Abstract Introduction Slide 18 Anatomy of the anaesthesia journal Slide 19 Slide 20 Slide 21 Editorials Rarely contain primary data Help interpret research and promote its use in practice Promote discussion Offer authoritative opinion Slide 22 Slide 23 What are review articles for? Answering clinical questions Keeping up to date Starting-point for future research Assimilating primary research Slide 24 Systematic review A review in which evidence on a topic has been systematically identified, appraised and summarised according to predetermined criteria Slide 25 Systematic review 1.Decide scope and purpose 2.Exhaustive search for material 3.Inclusion on pre-defined criteria 4.Quality assessment of relevant studies 5.Data extraction 6.Synthesis and integration 7.Interpretation Slide 26 Slide 27 Case reports Focus on individuals rather than populations Narrative power Archive of collective experience Sensitive to novelty: new benefits, complications, the unknown and unrecognised Slide 28 Slide 29 Correspondence The proper dialogue of science Extend journals peer review by readers comments, corrections and interpretation Not usually peer reviewed Under-rated and poorly indexed Slide 30 Conclusion Simple non-statistical principles can help make sense of research Evidence and opinion both have their place but should not be confused Bias is everywhere and must be taken into account Critical appraisal helps us identify good evidence

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