Module 4 Finding the Evidence: Individual Trials

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Presentation transcript:

Module 4 Finding the Evidence: Individual Trials

Evidence hierarchy EBM Literature: Reviews Meta analyses Systematic reviews Randomized control trials (RCTs) Controlled trials w/o randomization Cohort studies Case control studies/retrospective cohort Case studies/qualitative studies Individual Studies: Experimental Search ordr Level of evidence Individual Studies: Observational

Resources for Trials

Resources for Trials

CENTRAL

Resources for Trials

TRIP Database

TRIP Database

Resources for Trials

Appraisal - RAMMbo Recruitment Who did the subjects represent? Allocation Was the assignment to treatments randomized? Were the groups similar at the trial’s start? Maintenance Were the groups treated equally? Were outcomes ascertained & analyzed for most patients? Measurements Were patients and clinicians “blinded” to treatment? OR Were measurements objective & standardized?

Be careful 102 trial protocols (3736 outcomes)  122 published journal articles 62% of trials  discrepancy in outcomes 92% of trials  incomplete reporting of efficacy outcomes 86% of authors  denied existence of unreported outcomes despite evidence Statistically significant outcomes had a higher odds of being fully reported Chan JW, et al. 2004. Empirical evidence for selective reporting of outcomes in randomized trials: comparison of protocols to published articles. JAMA 291(20):2457

Module 4 Finding the Evidence: Individual Trials