Article Figures & Data
Figures
- Figure 1
Common types of research designs.7
- Figure 2
Hierarchy of evidence for individual clinical decision regarding therapy.
Tables
Five basic steps to taking an evidence-based approach- “5 Step Model.” 1. ASK: Formulate a focused, clinically pertinent question from a patient’s problem.
A strategy for formulating specific questions is the P.I.C.O.T.S acronym:
• Patient (the person presenting with the problem, or the Problem itself)
• Intervention (action taken in response to the problem, for example endoscopic surgery)
• Comparison (benchmark against which the intervention is measured, for example microscopic surgery)
• Outcome (anticipated result of the intervention, for example visual outcome)
• Time Frame
• Settings2. ACQUIRE: Searching for and retrieving of appropriate literature (best available research evidence) 3. APPRAISE: Critically review and grading of this literature (critically evaluating and appraising the evidence for its validity and usefulness), 4. APPLY: Summarizing and formulating recommendations from the best available evidence. 5. ACT: Recommendations from step 4 are integrated with the physician’s experience and patient factors to determine optimal care (that is, implementing the findings in clinical practice). Class of Evidence Study Designs I=Strong evidence Good quality (well designed), randomized clinical trial* II=Moderate evidence Moderate quality RT
Good quality cohort study (CS)
Good quality case control study (CCS)III=Weak evidence Poor quality RCT
Moderate/poor quality CS or CCS
Case Series, case reports, anatomical studies, expert opinion- Table 3
Common critical appraisal tools and reporting guidelines for specific study designs.36-43
Study Design Initiative Meaning Links Meta-analysis and systematic reviews PRISMA (Replaced QUOROM)41,42 Preferred reporting items for systematic reviews and meta-analyses (reporting checklist) http://www.prisma-statement.org/ AMSTAR42,43 Assessment of multiple systematic reviews (methodology checklist) http://www.biomedcentral.com/content/pdf/1471-2288-7-10.pdf Meta-analysis of observational studies MOOSE40,42 Meta-analysis of observational studies in epidemiology https://www.editorialmanager.com/jognn/account/MOOSE.pdf Randomized clinical trials CONSORT36,37,42 Consolidated standards of reporting trials http://www.consort-statement.org/downloads Observational studies STROBE39,42 strengthening the reporting of observational studies in epidemiology. http://www.strobe-statement.org/ Studies of diagnostic tests accuracy STARD42 Standards for the reporting of diagnostic accuracy studies http://www.stard-statement.org/ Other Resources EQUATOR42 Enhancing the quality and transparency of health research http://www.equator-network.org/reporting-guidelines/stard/ Level Strength Level Description Level I high degree of certainty Standard A Based on consistent class I evidence (well-designed RCT) B Single class I study or consistent class II evidence (especially when circumstances preclude RCTS) Level II moderate degree of certainty Guideline C Class II evidence (less well-designed RCT or one or more observational study) or a preponderance of class III evidence Level III unclear degree of certainty Option D (or I) Class III evidence (case series, case reports, and expert opinion)
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