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Evaluating Evidence from RCTs: Depression Treatments and Patient-Centered Outcomes

This module focuses on understanding and evaluating randomized controlled trials (RCTs) for mild or temporary depression. It reviews studies that measure the effectiveness of various interventions, specifically the use of St. John's Wort and its impact on patient-oriented outcomes. The Strength of Recommendation Taxonomy (SORT) is utilized to classify the quality of evidence and recommendations made based on consistent and high-quality studies. A systematic approach is introduced, involving the formation of clinical questions, evidence search, and case development.

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Evaluating Evidence from RCTs: Depression Treatments and Patient-Centered Outcomes

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  1. Module 6Making a Case

  2. Table of Evidence Study types Litsearch? Results consistent? Valid? Review # studies/part Outcome Linde, 2005 26/3320 RCTs Yes Yes Yes Moderate improvements for mild or temp depression ONLY Whiskey, 2001 14/1296 RCTs Yes No Yes Moderate improvements for mild or temp depression ONLY

  3. Table of Evidence Study Intervention Duration Study Type Sample Outcome Casper, 2006 600mg/daily 6-week RCT n= 205 Mean score (HMD) 123 I decreases: 82 C 11.6 for SJW 6.0 for placebo

  4. SORT A – Recommendation based on consistent and good quality (level 1 study quality) patient-oriented evidence Study Quality Diagnosis Scenarios Therapy/Prevention Scenarios Harm/Etiology Scenarios

  5. SORT A – Recommendation based on consistent and good quality (level 1 study quality) patient-oriented evidence B – Recommendation based on inconsistent and limited quality (level 2 study quality) patient-oriented evidence Study Quality Diagnosis Scenarios Therapy/Prevention Scenarios Harm/Etiology Scenarios

  6. SORT A – Recommendation based on consistent and good quality (level 1 study quality) patient-oriented evidence B – Recommendation based on inconsistent and limited quality (level 2 study quality) patient-oriented evidence C – Recommendation based on consensus, usual practice, opinion (level 3) study quality) disease-oriented evidence Study Quality All Scenarios

  7. SORT Patient-oriented evidencemeasures outcomes that matter to patients: morbidity, mortality, symptom improvement, cost reduction, and quality of life.Disease-oriented evidencemeasures intermediate, physiologic, or surrogate end points that may or may not reflect improvements in patient outcomes (e.g., cholesterol levels, blood chemistry, physiologic function, pathologic findings).

  8. SORT Ebell MH, et al. 2004. Strength of Recommendation Taxonomy (SORT): A Patient-Centered Approach to Grading Evidence in the Medical Literature. American Family Physician 69(3):548-556.

  9. Three simple steps Form a clinical question (PICO, search query) Find evidence (research) Make a case

  10. Module 6Making a Case

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