Final Review - drug info (gabe)

Final Review - drug info (gabe) - EBMI 1 - Principles of...

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EBMI 1 - Principles of EB-Practice o Rule of 5 A’s Assess: your pt or info need Ask: focused clinical question PICO (pt, intervention, comparison, outcome) Acquire: best evidence you can find Appraise: evidence Validity Apply: to pt care - Calculations: o RR (relative risk) = rate in exp erimental group (EER)/rate in control o RRR (relative risk reduction) = 100% - RR o ARR (abs risk reduction) = control rate – experimental rate o NNT ( # n e ed ed to treat) = 100%/ARR EBMI 2 – Shortcuts, Variations on RCT Results, Meta-Analysis of RCTs - Acquire, Appraise, Apply (all covered by ACPJC ) 1
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o ACP Journal Club Pulls highest quality articles Summarizes abstract - Acquire o PubMed – using limits - Therapy Q – ACQUIRE o Cochrane Library EBMI 3 – Diagnostic Test Trials, Observational Trials - Diagnostic test trials o Diagnostic Test: Question - ACQUIRE PubMed, PubMed Clinical Queries ACPJC o Diagnostic Test: APPRAISE Validity of the diagnostic test study (e.g. independent, blind comparison with gold standard?; appropriate spectrum of pts?) Results? Sensitivity = True Positives/Everyone with Disease o Proportion of patients with disease who came up POSITIVE o “True positive rate” Specificity = True Negatives/Everyone WITHOUT Disease o Proportion of pts without disease who came up NEGATIVE o “True negative rate” Likelihood Ratio = (likelihood pts with disease will have a given test result)/ (likelihood pts without disease will have same test result) o Or: with disease/without disease Other ways to analyze 2
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o sPin/sNout sPin = if specificity high, and result is positive, disease ruled IN sNout = if sensitivity high, and result is negative, disease ruled OUT - Observational Trials o Why run these? Outcome is: RARE Takes a long time to develop Association is suspected , but uncertain o Observational “Harm” Studies Cohort Prospective Pts followed from time of exposure until defined outcome occurs Uses relative risk (RR) Case Control Retrospective Researchers start with outcome, search backward to exposure Typically: outcome rare or takes a long time to develop 3
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Uses odds ratio (OR) o Appraise Therapy (RCT) validity standard? When pts can be ethically randomized to diff treatment arms Harm/Observation validity standard? Exposure known to be harmful or not feasible Harmful outcome is very rare - Levels of Evidence – Therapy - Summary o Optimal diagnostic test trials are gold standard comparison trials o measures of a test’s ability to distinguish between presence and absence of a disease o For harmful interventions, where randomization is unethical, observational trials often done Prospective is a COHORT = RRR, ARR, NNT ( see EBMI 1) Retrospective is CASE CONTROL = OR o Also use observational as alternative to RCT due to cheaper, faster, or rarer outcome o Lack of randomization? Requires statistical adjustment (lower quality, more bias) o Association causation EBMI 4 – Clinical Practice Guidelines 4
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Final Review - drug info (gabe) - EBMI 1 - Principles of...

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