Abstract
This article provides an introductory step-by-step process to appraise an article on harm. The authors introduce these principles using a systematic approach and case-based format. The process of assessing the validity of an article on harm, determining its importance, and applying it to an individual patient is reviewed. The concepts of study population homogeneity, equal treatment, sufficient follow-up periods, and completeness are discussed to help physicians determine an article's validity. Instruction on calculating odds ratios, relative risk, absolute risk increase, and the number needed to harm is provided and applied to the clinical scenario. Finally, information that is learned from the previous two steps is applied to patient care. Study generalizability and the role of patient values, patient expectations, and patient concerns are also addressed. The skills learned from appraising an article on harm in the manner outlined provides a solid basis for lifelong learning and improved patient care.
Evidence-based medicine (EBM) is the practice of using the most current research information to help guide clinical decisions while also fully taking into account patient values and circumstances.
1-3 This method of inquiry demands skill-development in appraising the validity, importance, and applicability of new clinical evidence to individual patients— and it begins when a physician formulates a clinical question during daily practice.
As noted, in this article, we introduce a strategy for busy physicians, physician residents, and medical students to critically assess the medical literature on harm. In-depth details of research methods are beyond the scope of this introductory series on EBM. Readers are encouraged to seek further training on these topics with supplemental learning opportunities and continuing medical education. Finally, the clinical scenario described has been simplified to provide readers with an illustrative example for the general concepts introduced.
Although most clinicians are already incorporating EBM principles in their practices, often instinctively, some physicians may require a more organized approach to integrating this relatively new model of self-education. Improved comfort levels and true expertise in the practice of EBM are the result of additional education, repetition, and self-assessment. The principles of EBM allow physicians to stay informed while also improving the quality of the information communicated to patients during patient encounters. The systematic approach that is used to appraise an article on harm is but one step in practicing EBM. Remember, the goal is always to provide the best care possible to patients—using one's clinical expertise to address patient values and expectations for treatment.
[Editor's note: This article is part 2 of a six-article series intended to introduce the principles of evidence-based medicine (EBM) to busy clinicians, physician residents, and medical students. Because the application of EBM is a career-long process, further training is needed beyond the information provided within this article and series. A foundation of knowledge about research methods is critical in understanding EBM; however, such details, though introduced, are beyond the scope of this series.]
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