A talk about critical appraisal, and how to read clinical research

1. 文獻評讀 楊宗翰 12/6, 2008

7. 實證概念 五步驟（問查讀用審） 實證精神（用最好的證據來照顧病人） 什麼是好的證據

8. Levels of Evidence 何種研究方法最適合解決這個問題（那種證據的等級最好）？

22. Exercise – PICO

23. Why PICO - 相關性 O C I P 審 查 問

27. P I/E C O T GATE Frame P articipants I ntervention ( e xposure) C omparison (control) O utcomes T ime Time (T) T Time (T) T

28. Participant Population: Source Population: Eligible Population: 68,561 women screened from 20 outpatients/community screening centres all eligibles invited (2763) Post-menopausal, established CHD, < 80 yrs, no MI in last 6 mths, no HRT last 3 months P

30. Epidemiologic evidence clinical considerations Policy issues Patient preferences X-factor: making evidence-based decisions clinical expertise: ‘putting it all together’ the art of medicine

31. Exercise – GATE Frame

34. GATE + RAM(M)bo O utcome I ntervention C omparator Test M aintained? R epresentation? P opulation B linded or O bjective? M easures O utcome M easures A llocation?

35. Exercise – RAMbo / CASP

39. 隨機化是否成功？

43. Loss follow-up (ITT vs PP) survival rate Rx B Rx A Rx B Rx A Loss or not complete 10% Rx B Rx A 80 80 80 70 80 80 survive 20 0 10 20 20 20 mortality 80.0% 100.0% 88.9% 77.8% 80% 80% PP 80% (80/100) 80% (80/100) 80% (80/100) 70% (70/100) ITT

46. Summary