Below is the evidence based medicine pyramid, which highlights different types of clinical studies, and the level of information that they contain.
In evidence-based medicine, decisions about treatments are determined by scientific research.
"Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients." Dr. David L. Sakett, Evidence Based Practice: what it is and what it isn't, 1996.
Evaluating scientific research to determine the best course of action is time-consuming and involved:
However, there are issues to look out for:
Individual case studies: These types of studies often describe a medical anomaly and spark the idea of a solution or treatment that is applicable to a broader population.
Clinical trials: new interventions are tested and reported.
Systematic reviews: the results from multiple trials are synthesized, studied, and evaluated.
Check out the TED talk below by Dr. Ben Goldacre to learn more about the dangers of publication bias:
Sometimes called a systematic "study of studies," a systematic review documents the results from multiple trials. The systematic review is defined by its comprehensive search approach in which researchers work to find all documented studies on a given research question. The results from searches are synthesized, studied, and evaluated in a transparent and heavily documented collaborative process. This is why a well conducted systematic review is one of the most useful types of research you can find.
Provides full-text access to Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Clinical Answers. "Cochrane reviews are systematic summaries of evidence of the effects of healthcare interventions. They are intended to help people make practical decisions." (The Cochrane Collaboration, 2019)
Provides bibliographical information for scholarly material in biomedical and pharmacological sciences.
Indexes journal articles in life sciences with a concentration on biomedicine. Contains material not yet indexed in Medline.
Uses Medical Subject Headings (MeSH) indexing with tree, tree hierarchy, subheadings and explosion capabilities.
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Case studies focus on in-depth documentation of one particular medical case that occurred in a real life context. They are useful when there is a need to explore an in-depth understanding of a particular issue or phenomenon of interest, particularly when an issue is not yet well understood.
Provides up-to-date and interactive content for basic science, clinical medicine, and post-graduate level cases for learning through exposure to realistic patient cases.
"Clinical trials are clinical research studies involving human participants assigned to an intervention in which the study is designed to evaluate the effect(s) of the intervention on the participant and the effect being evaluated is a health-related biomedical or behavioral outcome." (NIH, Office of Intramural Research, FAQ page) Clinical trials are useful when researching new interventions that have not yet been heavily documented.
While systematic reviews synthesize multiple studies, and meta-analyses provide statistical measures that summarize the data from these studies, not all systematic reviews are conducted well. This is why evaluation is key.
In order to assess the article for risk of bias, which is essential for critically appraising the evidence, we can move through the FRISBEE criteria:
F: Follow-up (Dropouts or those lost to follow-up create missing data that disrupt the balance in groups created by randomization—this can obscure results)
R: Randomization and concealed allocation (Randomization guarantees that each subject has the same chance of entering any group.)
I: Intention-to-treat (ITT preserves the balance of prognostic factors in groups created by the original random allocation. It avoids overly optimistic estimates of treatment efficacy resulting from excluding non-compliers)
S: Similar baseline characteristics (Similar baseline characteristics help to ensure that there are similar confounding variables, which helps to keep the study outcome balanced)
B: Blinding (Blinding equalized the effect of patient and therapist expectations on outcome)
E: Equal treatment (Equal treatment helps guarantee that the groups will remain prognostically balanced by avoiding systematic differences in care that could skew the results.)
E: Equivalence to your patient/population (How applicable is this study to the population that you are studying?)
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