1. Module 3 Finding the Evidence: Pre-appraised Literature

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

3. Address a single clinical question Locate and validate all trials/studies relevant to the question (inclusion and exclusion criteria) Should include an explicit literature search Draw a conclusion, if possible, based on multiple studies Meta-analyses Systematic reviews taken 1 step further Look for studies where the data can be combined large study End product is often displayed in a graphical format (forest plot) Review literature

4. 1990199520002005 2500 12,500 5000 10,000 7500 # published per year 15,000 2010 Growth of reviews

5. Finding worthy reviews

6. DARE DARE (CRD) commentary for: Gaster B, Holroyd J. St John's Wort for depression: a systematic review. Archives of Internal Medicine 2000; 160(2): 152-156

7. Finding worthy reviews

8. ACP Journal Club

9. Finding worthy reviews

10. Clinical Evidence

11. Finding any reviews

12. FocusSpecific Questions Question Is the specific purpose of the review stated? Is the review question clearly and explicitly stated? Literature Search Were comprehensive search methods used to locate studies? Was a thorough search conducted using appropriate databases? Were other potentially important sources explored? Study Selection What types of studies are reviewed? Are they the same type? How many participants in the review? Critical Appraisal Was the validity of included studies assessed? Are the validity criteria reported? Are the inclusion criteria reported? Similarity of Groups & Treatments Are treatments similar enough to combine? Were reasons for any differences between individual studies explored? Data Synthesis Were findings from individual studies combined appropriately? Are the methods used to combine studies reported? Are the results consistent across studies? Appraising reviews

13. Linde K, et al. 2005. St John's wort for depression: meta-analysis of randomised controlled trials. British Journal of Psychiatry 186:99-107British Journal of Psychiatry 186:99-107 An example

21. Still many interventions not covered by SRs The Cochrane Database is good example of this: approximately 10-15,000 Cochrane reviews are needed to cover interventions that have been investigated in clinical trials. After 18 years <50% have been published (completion is est. ~30 years). Need constant upkeep Half will need to be updated each year Most take 6-12 months to be developed and published Keep in mind

22. Module 3 Finding the Evidence: Pre-appraised Literature