实证医学之经验谈PPT.ppt

Critically Appraised Topic Presentation Example The study—the question and appraisal Study Question: In infants with bronchiolitis, do bronchodilator provide more benefits in clinical improvement than placebo? Critically Appraised Topic Presentation Example The study—the question and appraisal Randomisation: All were randomized, double-blind, placebo control trials. Ascertainment: Multiple RCTs analyzed in this meta-analysis review; this is adequate. Measurement: double-blind in treatment design through evaluation by clinical score, oxygenation, rate of hospital admission, duration of hospitalization. Critically Appraised Topic Presentation Example—Results Twenty-two clinical trials with 1428 infants with bronchiolitis were included in this review. In eight trials, with 468 infants, there was no improvement in clinical score for 43% of those treated with bronchodilators compared to 57% of those treated with placebo (odds ratio (OR) for no improvement 0.45, 95% confidence interval (CI) 0.15 to 1.29). There was a statistically significant but clinically modest improvement in the overall average clinical score (standardized mean difference (SMD) -0.48, 95% CI -0.62 to -0.33). Critically Appraised Topic Presentation Example—Results There was no statistically significant improvement in oxygenation overall (weighted mean difference (WMD) -0.57, 95% CI -1.17 to 0.03). Subgroup analyses showed a slightly greater effect size in outpatient studies, where there were shorter follow up durations, than in inpatient studies for both oximetry (outpatients WMD -0.84, 95% CI -1.59 to -0.10 versus inpatients WMD -0.25, 95% CI -1.18 to 0.67) and average clinical score (outpatients SMD -0.68, 95% CI -0.87 to -0.49 versus inpatients SMD -0.23, 95% CI -0.44 to -0.01). Critically Appraised Topic Presentation Example—Results Bronchodilator recipients showed no improvement in the rate of hospital admission after treatment as outpatients (18% versus 26%, OR 0.70, 95% CI 0.36 to 1