Interdisciplinary Seminar Series

Evidence Based Medicine - Therapy

Offered:

• August 15^th, 2005 at 1:00pm
• November 28^th, 2005 at 1:00pm

General Objectives
The student will learn the four steps of Evidence Based Medicine.

1. Step 1: Given a patient case, the student will write an answerable EBM question dealing with therapy. Questions will follow the PICO format [demographic and clinical patient information, interventions being compared, and outcome(s) of interest to the patient].
2. Step 2: Given an answerable EBM question, the student will conduct an efficient computerized search of the medical literature to identify one or more relevant medical research studies. NOT PART OF THIS SEMINAR
3. Step 3a: Given a medical journal research article, the student will identify the important elements - i.e., research design/methods, patients, treatments, and outcomes.
4. Step 3b: Given a list of validity questions, the student will critically appraise a medical journal research article.
5. Step 4: After critically appraised a medical journal research article, the student will apply the evidence to the patient case.

Specific Objectives for EBM Therapy
The student will

1. Write an answerable EBM therapy question using the PICO format.
2. For a medical journal research article on therapy, identify the important elements related to research design/methods, patients, treatments, and outcome(s).
3. For a medical journal research article on therapy, critically appraise the study using the following list of questions.
   Did experimental and control groups begin the study with a similar prognosis?
   • Were patients randomized?
   • Was randomization concealed (blinded or masked)?
   • Were patients analyzed in the groups to which they were randomized?
   • Were patients in the treatment and control groups similar with respect to known prognostic factors?
   Did experimental and control groups retain a similar prognosis after the study started?
   • Were patients aware of group allocation?
   • Were clinicians aware of group allocation?
   • Were outcome assessors aware of group allocation?
   • Was follow-up complete?
4. For a medical journal research article on therapy, determine the size and precision of the treatment effects - i.e., calculate:
   • Control Event Rate (CER)
   • Experimental Event Rate (EER)
   • Absolute Risk Reduction (ARR)
   • Relative Risk Reduction (RRR)
   • Number Needed to Treat (NNT).
   • Absolute Risk Increase (ARI)
   • Number Needed to Harm (NNH)
5. Apply the evidence to the patient case by answering the following questions.
   • Were the study patients similar to my patient?
   • Were all the clinically important outcomes considered?
   • Are the treatment benefits worth the potential harm and costs?

Students
Minimum Number: 4
Maximum Number: 15

Agenda
Students will be sent via email both a randomized controlled trial (RCT) and a systematic review (perhaps a meta-analysis) on a therapy for a prominent disease. Ideally, students will have read the papers prior to the seminar, but some time during the seminar will be allotted for focused reading.

The instructor will provide a concise set of materials and worksheets that will enable the student to (1) learn the concepts and principles of EBM - therapy, (2) critically appraise the distributed medical literature, and (3) apply the evidence to the patient.

There will be two 80-minute parts, one using an RCT, one using a meta-analysis.

RCT    • selective reading of the paper    • complete exercise in pairs    • reach consensus in small group    • plenary discussion Break Meta-analysis    • selective reading of the paper    • complete exercise in pairs    • reach consensus in small group    • plenary discussion Evaluation of session

minutes 15 20 25 20 15   15 20 25 20 5