MLA Annual Meeting: CE Recap

May 13, 2013 at 2:43 pm | Posted in Continuing Education, Professional Development | Leave a comment

702: Evidence-Based Practice: Introduction to Study Design and Critical Appraisal

Instructor: Connie Schardt, MLS, AHIP, FMLA, Duke University Medical Center.
Thanks to a NAHSL Professional Development Award, I was able to attend a CE class at the recent MLA Annual Meeting.The course was broken up into 4 one-hour sections, and I will briefly describe each of these.

1. Introduction and Study Design
This section of the course introduced participants to the “EBM Cycle”, which includes:

• Assessing the situation
• Asking a clinical question, PICOTT (PICO, with the additions of Type of Question and Type of Study)
• Acquire (literature search)
• Appraise (assess validity)
• Apply

Types of questions include therapy, harm, diagnosis, prognosis and prevention. In order by methodology beginning with those with the least strength to those with the strongest, most studies fit in the following categories: case reports (and case studies), case control studies, cohort studies, randomized controlled trials (RCTs), systematic reviews, and meta-analysis. There are also a number of qualitative studies in the literature (particularly in the field of nursing), which seek to explain behavior through observation. Participants also learned the strengths and weaknesses of each kind of study and how to search for them using PubMed (filters). Small group exercises challenged the class to identify article types after reading their abstracts.

2. Therapy: Critical Appraisal
Sources of potential bias were covered during this section. Important concepts include “Concealed Allocation Selection Bias” and “Blinding Assessment Bias”. Other topics to measure validity include similarity at baseline or similar prognosis. Equal treatment of both populations is also important, as the experimental intervention should be the only thing that differs between the control and experimental populations. The acronym, “FRISBE” was introduced. This acronym stands for Follow-up, Randomization and Concealed Allocation, Intention to Treat, Similar Baseline Characteristics, Blinding and Equal Treatment.

3. Therapy: Reviewing the Results
In this class segment, validity criteria for RCTs were explained. Participants were asked to do a bit of math to demonstrate the results of a study in absolute versus relative terms. Absolute provides the exact (numerical) difference while relative provides a proportional (percentage) difference. The class was introduced to a 2×2 table to explain absolute risk reduction and relative risk reduction. These are important distinctions, in particular when listening to news in the general media, press releases, etc., which often distort the significance of results. The concept of “number needed to treat” (the average number of interventions needed to produce a desired effect once) was introduced. Given this background, participants were asked to critically appraise a therapy article.

4. Systematic Review: Critical Appraisal
In this final section of the course, participants were introduced to meta-analysis, narrative analysis and systematic reviews and shown how they differ. The parts of a forest plot, which can be used to compare the quality of different studies, were reviewed. Participants also discussed the indicators of high-quality, thorough systematic reviews. Some of the quality indicators include clear objectives, and comprehensive and reproducible search strategies. These can also be expressed as “frame”, “find”, and “filter”. The process for building a quality systematic review was introduced, and these include specific processes for initiating, finding, synthesizing, reporting and hopefully, publication. The process could take up to a couple of years for completion. Knowledge was tested by having participants compare 3 systematic reviews for quality.

Rating: Highly recommended!

Suggested Resources (from Connie Schardt and others):

Introduction to Evidence-Based Practice(Duke University Medical Center Library and Health Sciences Library, UNC-Chapel Hill)
ACP Journal Club (Subscription)
AJN Series on Evidence-Based Practice in Nursing (Free from publisher)
Centre for Evidence-Based Medicine (University of Toronto)
Centre for Evidence-Based Medicine (University of Oxford)
Cochrane Handbook for Systematic Reviews of Interventions
Duke EBM Website – Evidence Based Practice (Libguide from Connie Schardt)
EBM Resources from Dartmouth
Evidence Based Medicine Course (SUNY Downstate)
National Guidelines Clearinghouse
TRIP (Turning Research Into Practice) Database


Guyatt, Gordon. Users’ Guide to the Medical Literature: Essentials of Evidence-Based Clinical Practice. American Medical Association. 2008.
Guyatt, Gordon. Users’ Guide to the Medical Literature: A Manual for Evidence-Based Clinical Practice. American Medical Association. 2008.
PDQ Evidence-based Principles and Practice. Anne McKibbon and Nancy Wilczynski, PMPH-USA, 2009.

I hope that you have enjoyed this overview and that you get the chance to take this excellent class!

Nathan Norris, MA, MLS, AHIP
Information Specialist
Beth Israel Deaconess Medical Center
Boston, MA 02215
p: 617-632-8311 | f: 617-632-8316


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