严格判读(Critical appraisal).PPT

Evidence Based MedicineCritical Appraisal 高雄榮民總醫院 臨床訓練中心 實證醫學組 徐圭璋 實證醫學五步驟 提出問題 (Question formulation) 搜尋證據 (Evidence search) 嚴格判讀 (Critical appraisal) 恰當運用 (Evidence application) 評估結果 (Outcome evaluation) 問題 住院醫師林玲玲對主治醫師的醫囑有所疑問，於是努力搜尋文獻， 終於找到幾篇論文，但是其中結論各有不同，而且也的文章感覺好像不太可信，又有的不太適用，因為沒有人較完整地教過她評讀論文，所以她實在不知道該怎麼辦。 答案？ 看是哪一本期刊？ 看屬哪一個國家？ 看從哪一個醫院？ 看自哪一個作者？ 還看什麼？ 嚴格判讀 (Critical appraisal) 信度 (reliability) 效度 (validity) 重要性 (importance) 實際運用之可能 (applicability) Oxford Center for Evidence-based Medicine Levels of Evidence (May 2001) 10 questions to help you make sense of randomised controlled trials  A. Are the results of the study valid? Screening questions 1. Did the study ask a clearly-focused question? Consider if the question is “focused” in terms of : the population the intervention the outcomes 2. Was this a randomised controlled trial (RCT)? Consider: why this study was carried out as an RCT if this was the right research approach for the question being asked Detailed questions 3. Were participants appropriately allocated to intervention and control groups? Consider: how participants were allocated to intervention and control groups. Was the process truly random? whether the method of allocation was described. Stratification, blocked etc? how the randomisation schedule was generated and how a participant was allocated to a study group if the groups were well balanced. if there were differences reported that might have explained any outcome(s) (confounding) 4. Were participants, staff and study personnel ‘blind’ to participants’ study group? Consider: the fact that blinding is not always possible if every effort was made to achieve blinding if you think if matters in this study the fact that we are looking for ‘observer bias’ 5. Were all of the participants who entered the trial accounted for at its conclusion? Consider: if any intervention-group participants got a control-group option or vice versa (cross-over?) if all participants were followed up in