Dr. Dawes,
I think the quick and dirty approach can be risky, the problem is that you
are never really aware of when you're heading down the wrong track. We can
all think of examples where lower levels of evidence have been trumped by
quality RCT's (hormone replacement therapy, hyperbaric therapy for carbon
monoxide poisoning, pneumatic anti-shock garments for traumatic shock).
Similarly, systematic reviews have enabled evidence-based decision making
when individual RCTs were inconclusive (low molecular weight heparin for
deep vein thrombosis).
As an emergency physician who has no choice but to make most of his
clinical decisions on a quick and dirty basis, I think the answer lies in
pre-appraised resources tailored to our specific needs. A favorite of mine
in emergency mediciine is the Best Bets database.
http://www.bestbets.org/
Best regards,
Dr. Eddy Lang
Sir Mortimer B. Davis Jewish General Hospital
McGill University
Montreal
At 09:02 AM 10/21/2002 -0400, you wrote:
>Following on from the checklist discussion. From personal use of appraisals
>over the years I have discovered a few items that may help
>
>the clinical question
>the search terms
>the databases searched
>the reason for selecting this(these) articles for appraisal -
>
>This last is the critical one - often articles are selected in the real
>world because of access to that article - not necessarily because they are
>the 'best level of evidence'. I have been to many teaching workshops where
>articles are selected by participants because they are available - 'we could
>not get a photocopy of the systematic review (not available full text on
>line) so we are gong to appraise this RCT' .While this is satisfactory for
>teaching it is not ideal for clinical practice(see below). This is one of
>the key areas where we need to be as transparent in our methods as possible.
>
>Without these items the appraisal can be taken out of context. More
>personally I have found going back to some of my own appraisals done 4 or 5
>years ago that without this information the appraisal is severely limited in
>its usefulness.
>
>Clearly as a physician I can only use what evidence I have access to - so
>this is an argument for a study - possibly theoretical - about whether the
>limited access we have to full text (although increasing) would affect the
>care of our patients. My hypothesis is that actually it is rare that we miss
>the killer paper that disproves the previous papers when we are using our
>limited clinical searches. More likely however is that the effect size is
>shown not to be so good or the diagnostic test not so successful. But I am
>happy to try & disprove my hypothesis - with the help of others. The
>question- 'Is quick & dirty EBM harmful?'
>Martin
>
>
>Department of Family Medicine
>University of McGill
>517 Pine Avenue West
>Montreal, Quebec H2W lS4
>Tel: (514) 398-7375 Fax:(514) 398-4202
>
>----- Original Message -----
>From: "Kate O'Donnell" <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Monday, October 21, 2002 7:48 AM
>Subject: Re: Critical appraisal of diagnostic studies
>
>
>> Dear Meryl
>>
>> I organise the Scottish Extended Course on EBP and, as part of that,
>> provide participants with a checklist for apprasing various types of study
>> design. The checklists themselves are derived from the JAMA checklists and
>> from CASP. We have now used these in many teaching sessions. The
>checklists
>> are available to download in pdf format and can be found at
>> http://www.gla.ac.uk/departments/generalpractice/ca_check.htm
>>
>> Hope this is helpful.
>>
>> Regards
>>
>> Kate.
>>
>> Dr Kate O'Donnell.
>> Lecturer in Primary Care R&D.
>> Tel: 0141 211 3378/1668.
>> Email: [log in to unmask]
>>
>>
>>
>>
>> -----Original Message-----
>> From: Meryl Lovarini [SMTP:[log in to unmask]]
>> Sent: Thursday, October 17, 2002 7:21 AM
>> To: [log in to unmask]
>> Subject: Critical appraisal of diagnostic studies
>>
>> Hi Everyone,
>> Does anyone know of any critical appraisal checklists that could be used
>> for assessing the quality of studies related to
>> diagnosis/assessment/screening. Sacketts book (2000 edition.), Evidence
>> based medicine, How to practice and teach EBM lists a series of questions
>> that should be considered when reviewing theses types of studies (pp 67 -
>> 93), but has anyone used a checklist for this?
>> Thanks
>> Meryl Lovarini
>> Research Project Manager
>> University of Western Sydney, Australia
>> [log in to unmask]
>> << File: ATT00055.html >>
>>
>>
>
Dr. Eddy Lang CCFP(EM) CSPQ
Attending Physician, SMBD Jewish General Hospital
3755 Cote Ste Catherine
Montreal, Quebec
H3T 1E2
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