The heart of evidence based medicine is learning how to critically
appraise the medical literature. This page will give you the tools on
how to approach an article in a systematic, step-by-step fashion.
Step 1: Find an Article to examine more closely
An article you choose can come from one of two ways.
1. Through a PICO
where you answer an answerable clinical question.
2. You find an interesting article that you would like to look at more
closely. For instance, the Women's Health Initiative, or a similar landmark
trial.
Step 2: Determine what type of question the article is answering
After you pick your article, determine what question the article is
trying to answer. Is it a treatment alternative? Or is it how to improve
the diagnosis of a disease process? Perhaps it's a question about the
harm of a particular drug or the prognosis of a disease. Also try to
determine if the study
design is appropriate to answer the question.Once you determine
the appropriate question, move to Step 3.
Step 3: Pick the appropriate Worksheet
Now, pick the appropriate worksheet (Therapy,
Harm, Diagnosis,
Prognosis), get the article
and work it through! All worksheets are designed to walk you through
the article. If you have any questions, please ask your staff or the
fellows! All your worksheets are found in the resource section of the
website, or under the particular section (i.e. the Therapy worksheet
is found under the Therapy
webpage.)
Which study designs answer which questions best?
Etiology, Causation, Harm
Cohort study > Case control > Case series > Cross sectional
study.
Diagnostic Testing
Prospective, blind comparison to the gold standard
Prognosis
Cohort study > Case control > Case series
Therapy, Prevention
Randomized Controlled Clinical Trial (RCT) > Cohort > Case Control
Clinical Examination
Prospective, blind comparison to gold standard
Cost
Economic Analysis (cost-benefit analysis)
Educational Design
RCT > Cohort study (consider the ERIC database)
Health Services
RCT > Cohort Study (consider HealthSTAR database)
Synthesis articles
Systematic Review / Meta-analysis / Practice Guidelines.
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