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11 Cards in this Set
- Front
- Back
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Hierachy of Evidence..from least to greatest
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1. Basic Science/Animal→Case Reports→Case Series→Case Control Study→Cohort Study→Randomized Control Trial(ACAS,NASCET)→Systematic Review(Chaturvedi)→Meta-Analysis
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Hills Criteria 1-3:
1 Strength of Association. 2 Temporal Relationship 3 Dose Response Relationship |
1. Statistical indication of causality
2. A must come before B to indicate causality. 3. Linear relationship BUT not necessary for causality. |
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ACAS study shows...
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*Carotid Disease leads to Stroke
*Statistical Correlation displayed *Macular Hole in the left eye-Asymptomatic no problem *Men did better than women |
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NASCET study shows...
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*Carotid Disease leads to Stroke
*Statistical Correlation displayed *Dose-Response relationship *50-74% carotid stenosis on the LEFT- MODERATE severity *>75% carotid stenosis on the RIGHT-SEVERE *Men did better than women |
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Hills Criteria 4-6
4. Consistency 5. Plausibility 6. Consideration of Alternate Explanations |
4. Same result regardless of study/population-european agreed w/ american
5. Agrees w/ current understanding of pathology-by extension from coronary disease 6. Extent to which other options were considered-self evident process |
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Hills Criteria 6-8
6.Experiment 7.Specificity 8.Coherence |
6. condition can be altered by experiment-surgical intervention
7. single cause produces and effect. absence of which does not negate causality-specific for symptomatic disease 8. compatible association with existing theory and knowledge-coherence was met |
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Name possible limits to study
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Studies were old. Results aren't generalizable
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Other factors: age, type of event, other comorbidities
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1. older patients have better results(above 80 not studied)
2. Retinal TIA had less benefit in moderate grade disease 3. worse outcome w/ DM, high Dias BP, no hx of MI, contralateral coratid occlusion, stroke on CT/MR, left sided disease; better outcome-recent stroke of TIA |
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What Should you do?
1. Scenario One: moderate grade stenosis and retinal TIA/STROKE 2. Scenario Two: atypical event with symptomatic stroke, however, and severe stenosis 3. Scenario Three: asx moderate grade on left and severe grade on right. |
1. Scenario One: moderate grade stenosis and retinal TIA/STROKE: Operate
2. Scenario Two: atypical event with symptomatic stroke, however, and severe stenosis: Operate 1. Scenario Three: asx moderate grade on left and severe grade on right: Operate on right if patient desires (otherwise, f.u carotid ultrasound in 6-12 months)-no ‘right answer’ |
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For each clinical issue state the best type of study.
1. Therapy 2. Diagnosis 3. Etiology/Harm 4. Prognosis 5. Prevention |
1. Randomized Cntrl Study
2. Prospective comparison of a new test to a Gold Standard(blinded) 3. RCT 4. Cohort 5. RCT |
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State the EBM Levels
I. II. III.1 III.2 III.3 IV |
Evidence from....
I. Systematic review of all RCTs II. One properly designws RCT III.1 Well designed psuedo-randomized RCT III. 2 Comparative study w/ concurrent controls and allocation not randomized(cohort study, case-control analytic study or interrupted time series with a control group III.3 Comparative study with historical control, two or more single arm studies or interrupted time series without a parallel control group IV. case series either post test or post test and pre test |
