Experimental studies
Increase the #older people
progress healt care
increase in levels of wealth
better nutrition
reduced fertility rates
from reasearch to decision -making 5 stages
- EBM (evidence based medicine)
- outcome analysis (benefit-risk ratio)
- costs
- cost vs efectivness analysis
- ethical & legal analysis
divided in:
guidelines & polices
individual decision making
3 parts:
patient's values & expectations
individual clinical expertise (doctor)
beste available clinical evidence (efficacy)
observations in a systematic way (compile, organize, evaluate) ⇒
case series ⇒
systematic observations ⇒
meta-analysis
design
analytic
observational
experimental (needs ethical approval)
uncontrolled
controlled
Randomized (RCT)
non-randomized
cohort
case-control
cross-sectional (prevalence)
to test
formulation of a clinical question
efficacy (explanatory trials) ⇒ ideal
effectivness (pragamatic trials) ⇒ real world clinical settings
structure
in 2 groups by randomization
experimental
control
- population of eligible patients
inclusion cryteria
exclusion cryteria
- group of patient
- at least 2 tratment groups
- allocation by randomization
- comparison of outcome measures
to test the mean behavior of a target population
CONSORT (consolidated standards of reporting trials)
methods
trial design
parallel
crossover
factorial
cluster trials
split body trials
superiority
equivalence
non-inferiority
participants
clear definition of inclusion /exlcusion cryteria + info on setting and locations ⇒ applicability & generalizability
outcomes
interventions (how & when)
primary ⇒ to calculate the sample size
time point of primary interest
Health-Related Quality of Life
Quality-adjusted life years (quality & quantity) ⇒ cost-utility analysis
estimation of th eclinical difference between groups
Significance level⇒ tipe I error (reject H0 when is true)
Statistical power ⇒ tipe II error (not reject H0 when is false)
stdv (continuos outcomes)
dropout rate
blinding
who
patient
assessor
operator ( difficult for rehab)
double or single or complete
statistical methods
treatment effect ⇒ 95% confidence interval
statistical signifiance (P-value)
comparison of baseline values
logitudinal methods analysis (with follow-up)
parametrics test (continuos variables, normal distrib)
non-parametric (categorical variables)
results
continuos group
sym ⇒mean & stdev
asym ⇒median & interquartile range
discussion
underline the difference between significance & clinical importance
non_significace != equivalence
external validity (generalization)
internal validity (prerequisite for ext)
systematuc review to compare results
specific research question
systematic methods to min bias
contains meta-analysis (estamate effects)
cochrane collaboration ⇒ well-informed decision about healt-care.
bias
selection
allocation
assessment
publication
stopping