BASIC STEPS IN JOURNAL SEARCH & REVIEW I. Clinical Question (PICO) P - Population I - Intervention C - Standard of Care O - Outcome II.

Comparator Standard of Care Diagnostics Therapeutics None for harm & prognosis III. Baseline Variable Standard of Care Pretest Probability for Diagnosis Therapeutics Prognosis Harm IV. Intervention - Will it be better? Diagnostics Therapeutics V. Literature Search

DATABASE LIMITS HIERARCHY Meta-analysis RCT Cohort Cross-section Case Control Case Series Case Report Expert Opinion Evaluate Directness (PICO) VI. Test for Validity VII. Result if Valid Diagnosis: LRs, Sn, Sp, p-value Therapy: Dichotomous or continuous Point Estimates,RR, ARR, NNT, p-value, int Look for another if not valid VIII. Applicability Diagnosis: post test using Fagan's Normogram compare post and pretest probability

Therapeutics current risk using result of the study current risk and baseline risk IX. Biological issues Availability Cost and Feasibility

H & REVIEW

ntinuous R, NNT, p-value, interval estimate, p-value, level of significan

gan's Normogram est probability

of the study

e, level of significance

WORKSHEET - HARM
1. Clinical Question: Among a. Population b. Intervention c. Standard d. Outcome 2. Article Search: Database: x www.pubmed.com www.cochrane.org http://jama.jamanetwork.com/journal.aspx 0 what is the

(PCMC@2013)

Keywords: Article (pdf or html): 3. Appraising Validity

http://www.ncbi.nlm.nih.gov/pubmed/20195633 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890074/pdf/431_2010_Artic

1. Were the patient groups being comopared sufficiently similar with respect to baseline characteristics? If n 2. Were unbiased criteria used to determine exposure in all patients?

2. Were unbiased criteria used to detect the outcome in all patients? (blinding) 3. Was the follow-up rate adequate?

4. Apprasing Results 1. How strong is the association between exposure and outcome? A. RCTS and Cohorts Outcome No Outcome Exposed a b Unexposed c d

RECRUITMENT

Relative Risk (RR) a= b= c= d=

1 1 1 1

a/ (a+b) / c/(c+d) = a+b = c+d = a / (a+b) = c / (c+d) =

1 2 2 0.5 0.5

B. Case-control Studies RECRUITMENT Outcome No Outcome a b c d

Exposed Unexposed

RESULT Odds Ratio (OR) a= b= c= d= (a/c) / (b/d) = 1 a/c = 1 b/d = 1 1 1 1 1

2. How precise is the estimate of the risk? OR = value [ % CI:lowest limit, upper limit] i.e. OR=1 Presented as confidence interval = % sure that the true strength of association (the odds ratio 5. Assessing Applicability 1. Sex 2. Co-morbidities 3. Race 4. Race 5. Age 6. Pathology 7. Socioeconomic factors 6. Individualizing the result

6. Answer

(PCMC@2013)
0.00 of 0.00 Directness of the Study (Article from Step 2) in comparison with 0.00

http://www.pchrd.dost.gov.ph/ http://www.thelancet.com/

network.com/journal.aspx

nlm.nih.gov/pubmed/20195633 nlm.nih.gov/pmc/articles/PMC2890074/pdf/431_2010_Article_1160.pdf

ufficiently similar with respect to baseline characteristics? YES If not, were statistical adjustment NO made? posure in all patients? YES NO

tcome in all patients? (blinding)

RESULT

( RR > 1 suggest harm)

(exposed) (unexposed)

(OR > 1 suggests harm) (outcome) (no outcome)

OR = value [ % CI:lowest limit, upper limit] i.e. OR=14[95% CI:3.3,59.3] = % sure that the true strength of association (the odds ratio lies within the range)

http://pps.ivant.com/search.do

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AVENGERS Searched Articles Acero, Angelyn Carreos, Ma Elarnie Inoncillo, Millette Millora, Hasmin Prabowo, Johanes Sy, Romelyn Alonzo, Diana Cabaltera, Twinkle Conti, Mary Angeli De Lara, Katrine Anne Moreno, Leah Grace Pua, Jerry Tee, Phoebe Aguilera, Chrys Bernardus, Andrew Cue, Monna Lisa Go, Camille-Marie Imperial, Melady Magalit, Shanta Ramirez, Joyce Ruanto, Maria Theresa Villar, Cherry May Appraised Journals Score