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EVIDENCE BASED PRACTICE. BY MOHEB KHOUZAM MD. EVIDENCE BASED PRACTICE. 1- TYPES OF STUDY DESIGNS 2- RECOMMENDATIONS. EVIDENCE BASED PRACTICE. 1-TYPES OF STUDY DESIGNS. 1-TYPES OF STUDY DESIGNS. A. INTERVENTION STUDIES. 1-TYPES OF STUDY DESIGNS. Intervention Prospective Random method

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EVIDENCE BASED PRACTICE


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evidence based practice

EVIDENCE BASED PRACTICE

BY MOHEB KHOUZAM MD

evidence based practice1
EVIDENCE BASED PRACTICE
  • 1- TYPES OF STUDY DESIGNS
  • 2- RECOMMENDATIONS
evidence based practice2
EVIDENCE BASED PRACTICE

1-TYPES OF STUDY DESIGNS

1 types of study designs
1-TYPES OF STUDY DESIGNS

A. INTERVENTION STUDIES

1 types of study designs1
1-TYPES OF STUDY DESIGNS
  • Intervention
  • Prospective
  • Random method
  • Experimental and control groups

RANDOMIZED CONTROLLED TRIALS (RCT)

1 types of study designs2
1-TYPES OF STUDY DESIGNS

CONTROLLED TRIALS WITHOUT RANDOMIZATION

  • Intervention
  • Prospective
  • No randomization
  • Experimental & control groups
1 types of study designs3
1-TYPES OF STUDY DESIGNS

B-OBSERVATIONAL STUDIES

1 types of study designs4
1-TYPES OF STUDY DESIGNS

COHORT STUDIES

  • Exposure status known
  • Follow-up for a period of time
  • Determine presence or absence of disease
    • (i) Prospective: groups of exposed & unexposed followed-up for a period to determine outcome
    • (ii) Retrospective: both exposures & outcomes occurred.
  • Rate of disease in exposed / Rate of disease in unexposed gives Relative Risk
1 types of study designs5
1-TYPES OF STUDY DESIGNS

CASE CONTROLLED STUDIES

  • Retrospective
  • Group of subjects with specific outcome (cases)
  • Group of subjects without specific outcome (controls)
  • Over a period of time
  • Here starting point is disease status
  • Compare extent of exposure to a variable of interest
  • Odds of exposure in cases/odd of exposure in controls= Odds Ratio
1 types of study designs6
1-TYPES OF STUDY DESIGNS

B- OBSERVATIONAL STUDY

1 types of study designs7
1- TYPES OF STUDY DESIGNS

CROSS SECTIONAL STUDIES

  • Observational
  • Assess the status of individuals with respect to presence or absence of both exposure &outcome at a particular time.
  • Prevalence is the proportion of individuals with a disease at a particular time
  • Incidence is the number of new cases occurring over a specified period of time
1 types of study designs8
1-TYPES OF STUDY DESIGNS

UNCONTROLLED INVESTIGATIONAL STUDIES

  • Observational
  • Report the results of treatment or interventions in a particular group
  • No control group
1 types of study designs9
1-TYPES OF STUDY DESIGNS

B- OBSERVATIONAL STUDY

1 types of study designs10
1-TYPES OF STUDY DESIGNS

DESCRIPTIVE STUDIES

  • Provide limited information on relationship between exposure and outcome of interest
  • Case study describes clinical characteristics or interesting features in a single patient
  • Case series describes the same in a series of patients
1 types of study designs11
1-TYPES OF STUDY DESIGNS

EXPERT OPINION

  • Findings from expert panels and committees and the opinions of respected experts in a particular field
1 types of study designs13
1-TYPES OF STUDY DESIGNS

DECISION ANALYSIS

Decision Tree, branches are key problems or decisions

Driven by key assumptions

Death

Long Term disability

Operative complications

Total

Cure

Uneventful

Cure

Hysterectomy

Uneventful

Cure

Death

Subtotal

Long Term disability

Operative complications

Cure

1 types of study designs14
1-TYPES OF STUDY DESIGNS
  • META-ANALYSIS
  • Effect on endometrial cancer: smoking vs. no smoking
  • Weighted average of a variable/intervention on a defined outcome
  • Beers
  • Dipalo
  • Henry
  • Zo
1 type of design studies
1-TYPE OF DESIGN STUDIES

COST-BENEFIT ANALYSIS

  • Compares costs associated with an intervention with the net monetary benefits from the use of that intervention
1 types of study designs15
1-TYPES OF STUDY DESIGNS

COST-EFFECTIVENESS ANALYSIS

  • Compares the net monetary costs of an intervention with some measure of clinical outcome
2 recommendations
2-RECOMMENDATIONS

BASED ON QUALITY & QUANTITY OF EVIDENCE

2 recommendations1
2-RECOMMENDATIONS
  • A There is good evidence to support recommendations
  • B There is fair evidence to support recommendations
  • C There is insufficient evidence to support recommendations, but recommendation is made on other grounds
  • D There is fair evidence against recommendations
  • E There is good evidence against recommendations
  • There is no exact correlation between strength of recommendations and level of evidence