CPP2017 Systematic reviews spl

Question 1

what is evidence-based medicine?

Answer 1

the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients
- mostly using systematic reviews

Question 2

what is the Cochrane library used for?

Answer 2

a key resource for systematic research
- provides high-quality systematic reviews of randomised controlled trial (RCT) evidence on healthcare interventions

Question 3

what is the cycle of evidence-based medicine?

Answer 3

1. identify a focused answerable question
2. search for the evidence
3. critically appraise the evidence
4. apply to practice
5. audit the practice
6. modify the practice…

Question 4

what is PICO?

Answer 4

• population (what characteristics does patient have)
• intervention (what treatment/care/factors are you inputting)
• comparison (alternative to consider/placebo/no intervention)
• outcome (what are you expecting/measuring)

Question 5

why is Trip medical data base very useful?

Answer 5

• uses high-quality evidence based resources including NICE and Cochrane library
• ranks results by level of evidence and allowsn= filtering

Question 6

what is the pyramid for evidence in clinical medicine?

Answer 6

• the higher up the pyramid, the higher quality
• evidence-based guidelines at the top (secondary evidence)
• systematic reviews second (secondary evidence)
• primary evidence at the bottom = individual studies, e.g. RCTs, cohort, cross-sectional, case-control studies

Question 7

what is secondary evidence

Answer 7

evidence from gathering, summarising and analysing primary research sources
- gives more conclusive results on a single question from multiple resources
- e.g. systematic reviews, evidence-based guidelines

Question 8

what is primary evidence

Answer 8

• first-hand raw information/evidence from a single study
  -e.g. cohort study, RCT

Question 9

what are the main 2 medical databases?

Answer 9

Pubmed, medline

Question 10

what is a pre-appraised evidence resource?

Answer 10

where authors have searched for all available evidence, appraised it to select only the most trustworthy and presented it in a easy to use format

Question 11

what are systematic reviews of randomised controlled trials (RCTs) used for?

Answer 11

• address a specific research question
• use a range of medical databases
• tries to include all published and unpublished trials on the research question
• has more than 1 investigator involved in assessing the eligibility of the studies
• assess the methodological quality of each trial
• makes an assessment if the treatment effects differ substantially
• uses meta-analysis to combine results from individual trials
• produces a combines treatment effect that will have a smaller confidence interval than the individual trials

Question 12

what is the purpose of a forest plot?

Answer 12

• graphical representation of the findings from multiple studies
• compare between studies and statistical significance
• shows the confidence intervals and risk ratios

Question 13

what is heterogeneity?

Answer 13

• variability among studies in a systematic review, the results in each study are not consistant
• a high p-value for heterogeneity suggests it is insignificant which is good and the results are valid

Question 14

what does a risk ratio of 0.83 mean?

Answer 14

there is a 17% decreased risk of the outcome

Question 15

what does a risk ratio of 1 or greater mean?

Answer 15

there is no reduction in the risk of the outcome/ there is an increased risk of the outcome