Monday, April 17, 2017

Research and Evidence Based Medicine

Definition: "the integration of best research evidence with clinical expertise and patient values"

Hierarchy of Evidence:

Level 1a:  Systematic Reviews of Randomized Control Trials
  • Comprehensive survey of a topic in which all primary studies of the highest level have been identified, analyzed and appraised
  • Assessed by individual reviewers
  • Cochrane systematic review is a type of review specifically used in health care.
Level 1b:  Individual Randomized Control Trials
  • Type of research design in which participants are randomly split between 2 groups
  • One group is the intervention group, one is the control group
  • The control group receives either no treatment or a default treatment
  • Random assigning reduces risk of bias
Level 2: Cohort Study
  • Observational study of subjects with a specific condition and/or who are receiving a specific treatment
  • Followed over a period of time
  • Comparisons are made from the 2 groups, the cohort and possibly the gerneral population
  • Limitations include lack of control of variables
  • Not as reliable as RTC's
Level 3: Case Control Study
  • A study that involves identifying subjects who have the outcome of interest and control subjects without the same outcome, and looking back to see if they had an exposure of interest
  • Typically done retrospectively, looking back over time, example is smoking as a link to lung cancer
Level 4: Case Report or Case Series
  • Describes the medical history of one participant
  • Used to record and alert other health care professionals to occurrences 
  • No control group
  • Not statistically valid

Level 5: Expert Opinion

Other Things to Consider:

Ethical Considerations:
  • Informed consent, confidentiality, Protection from harm or danger, Knowledge of the outcome

  • Independent Variable: the factors manipulated by the researcher
  • Dependent Variable: the factors used to measure the effect of the independent variable (the "effect" or outcome of interest)

  • Descriptive statistics: Summarize or describe important characteristics of a known set of data
    • used to determine whether there are significant differences between groups

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