1. Module 4 Finding the Evidence: Individual Trials

2. 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

3. Resources for Trials

4. Resources for Trials

5. CENTRAL

6. Resources for Trials

7. TRIP Database

8. TRIP Database

9. Resources for Trials

10. 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?

11. 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 Empirical evidence for selective reporting of outcomes in randomized trials: comparison of protocols to published articles. JAMA 291(20):2457

14. Module 4 Finding the Evidence: Individual Trials