How to appraiseMedical Journal

(Therapy)

นพ. บรบูิรณ์ เชนธนากิจหน่วยเวชศาสตรฉ์กุเฉิน

ภาควชิาเวชศาสตรค์รอบครวัคณะแพทยศาสตรม์หาวทิยาลัยเชยีงใหม่

Patient Concerns

Clinical Expertise

Best research evidence

EBM

What is EBM?

Are the result valid?What are the results? How can I apply the result to patient care?

Critical appraisal

Are the result valid? ประเด็นท่ีต้องประเมนิวา่ RCT นัน้น่าจะมี BIAS

หรอืไม่

• Did Intervention & Control groups start with same prognosis?

• Was prognostic balanced maintained as the study progressed?

• Were the groups prognostically balanced at the study’s complettion?

• Did Intervention & Control groups start with same prognosis?

•Were patients randomized?•Was randomization concealed?•were patients similar in respect to known prognostic factor

• Was prognostic balanced maintained as the study progressed?

• Were the groups prognostically balanced at the study’s completion?

Are the result valid?

Randomization

Randomization

• Did Intervention & Control groups start with same prognosis?

• Was prognostic balanced maintained as the study progressed?

1.To what extent was the study blinded?

• Were the groups prognostically balanced at the study’s completion?

Are the result valid?

Blindness

Co-intervention/Confounders

• Did Intervention & Control groups start with same prognosis?

• Was prognostic balanced maintained as the study progressed?

• Were the groups prognostically balanced at the study’s completion? • Was follow up complete?• Were patients analyzed in the group to

which they were randomized?

Are the result valid?

Intention to treat analysis

Are the result valid?What are the results? How can I apply the result to patient care?

Critical appraisal

• How large was the treatment effect?

• How precise was the estimate of treatment effect?

What are the result?

Treatment effect

Treatment effect

Treatment effect

Are the result valid?What are the results? How can I apply the result to patient care?

Critical appraisal

• Were the study patients similar to my patient?

• Were all clinically important outcomes considered?

• Are the likely treatment benefits worth the potential harm and costs?

Apply to patient care?

“ขอ้ซกัถาม”

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