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EVIDENCE BASED REVIEWS IN SURGERY
a program of the
CANADIAN ASSOCIATION OF GENERAL SURGEONS

L'ASSOCIATION CANADIENNE DES CHIRURGIENS GÉNÉRAUX


Evidence Based Reviews in Surgery - Archives

EBRS packages are available dating back to 2000. If you would like access to any of these packages/articles, you can do so by accessing the following:

  1. Chronologically (by month and year) This allows access to the complete package, included are the questions related to the methodology, the methodological and clinical articles and the methodological and clinical reviews.

  2. Index of Methodological and Clinical Topics This allows you to access either the methodological or clinical topics of interest; a list of articles will appear. To retrieve an article on this topic you can click on it and it will bring up the article.

Display all in chronological order
May 2014

Topics
1. Clinical Topic: Comparison of clinical registry and administrative claims data for reporting 30-day surgical complications
2. Methodological Topic: Administrative Data
 
Questions

Please read the above articles and be prepared to discuss the following:

  1. What is the clinical question being addressed?
  2. What is the study design? Is it appropriate?
  3. What is the rationale for the study?
  4. What are the sources of data?
  5. Are the data accurate and valid?
  6. What outcomes were considered?
  7. How large and precise was the difference in the outcome?
  8. Are there any factors (confounders) that might explain the difference in the results?
  9. State the conclusion. Have the authors addressed the clinical question posed?
  10. Does the evidence support the conclusion?
Articles

1. Comparison of clinical registry and administrative claims data for reporting 30-day surgical complications; Lawson EH, Louie R, Zingmond DS, et al. A comparison of clinical registry versus administrative claims data for reporting of 30-day surgical complications. Ann Surg 2012;256:973-981

2. Assessing quality using administrative data;

Iezzoni LI. Assessing quality using administrative data. Ann Int Med 1997;127:666-674


3. NSQIP; Reference articles on NSQIP: Khuri SF. The NSQIP: A new frontier in surgery. Surg 2005;135:837-843

4. NSQIP - Measuring quality of surgical care;

Khuri SF, Daley J, Henderson W, et al. The Department of Veteran Affairs' NSQIP. The first national validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. Ann Surg 1998;228(4):491-507

 
Reviews
Clinical Review (Can): Geoff Porter - Dalhousie University
Clinical Review (US): Justin Dimick - University of Michigan
Methodological Review: Lillian Kao - University of Texas Health Centre

April 2014

Topics
1. Clinical Topic: C-Reactive protein predicting safe and early discharge after colorectal surgery
2. Methodological Topic: Meta-analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Did the review explicitly address a sensible clinical question?
  3. Was the search for relevant studies detailed and exhaustive?
  4. Were the primary studies of high methodolgic quality?
  5. Were the assessments of studies reproducible?
  6. Were the results similar from study to study?
  7. What are the overall results of the review?
  8. Were the clinically important outcomes considered?
  9. State the conclusion. Have the authors addressed the clinical question posed?
  10. Does the evidence support the conclusion?
Articles

1. C-Reactive protien predicting safe and early discharge after colorectal surgery; Warshkow R, Beutner U, Steffen T, et al. Safe and early discharge after colorectal surgery due to C-Reactive protein. Ann Surg 2012;256:245-250

2. Meta-analysis; Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology. JAMA 2000;283(15):2008-2012
 
Reviews
Clinical Review (Can): Marc Jeschke - University of Toronto
Clinical Review (US): John Monson - Rochester University
Methodological Review: Prosanto Chaudhury - McGill University

March 2014

Topics
1. Clinical Topic: Prospective observational mulicenter, major trauma transfusion (PROMMTT) Study
2. Methodological Topic: Prognosis/Natural History
 
Questions
  1. What is the clinical question being addressed?
  2. Was there a representative and well-defined sample of patients at a similar point in the course of the disease?
  3. Was follow-up sufficiently long and complete?
  4. Were objective and unbiased outcomes criteria used?
  5. Was there adjustment for important prognostic factor?
  6. How large is the likelihood of the outcome event(s) in a specified period of time? How precise are the estimates of likelihood?
  7. Will the results help me in caring for my patients?
  8. Will the results lead directly to selecting or avoiding therapy?
  9. Are the results useful for reassuring or counseling patients?
  10. State the conclusion. Have the authors addressed the clinical question posed?
  11. Does the evidence support the conclusion?
Articles

1. Prospective observational multicenter, major trauma transfusion (PROMMTT) study; Holcomb JB, del Junco DJ, Fox EE, et al for the PROMMTT Study Group. The prospective, observational multicenter major trauma transfusion (PROMMTT) study. Arch Surg 2012;15:1-10. doi: 10.1001/2013.jamasurg.387 [Epub ahead of print]

2. How to use an article about prognosis - surg literature;
Hansebout RR, Cornacchi SD, Haines T, et al; for the Evidence-Based Surgery Working Group. Usersí guide to the surgical literature. How to use an article about prognosis. Can J Surg 2009;52(4):328-36
 
Reviews
Clinical Review (Can): Chad Ball - University of Calgary
Clinical Review (Can): Katerina Pavenski - University of Toronto
Clinical Review (US): Juan Duchesne - Tulane University
Methodological Review: Andrew Kirkpatrick - University of Calgary

February 2014

Topics
1. Clinical Topic: Loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for C difficle
2. Methodological Topic: Bias
 
Questions
  1. What is the clinical question being addressed?
  2. What is the study design?
  3. What is the source of data?
  4. Are the data accurate and valid?
  5. Are the outcomes appropriate?
  6. What are the results?
  7. Is there adequate clinical information?
  8. Is there appropriate risk adjustments?
  9. Are the results generalizable?
  10. State the conclusion. Have the authors addressed the clinical question posed?
  11. Does the evidence support the conclusion?
Articles

1. Loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for C difficle; Neal MD, Alverdy JC, Hall DE, et al. Diverting loop ileostomy and colonic lavage. An alternative to total abdominal colectomy for the treatment of severe, complicated Colistridium difficile associated disease. Ann Surg 2011;254:423-429

2. Bias in Surgical Research; Paradis C; Bias in Surgical Research. Ann of Surg. 2008;248(2):180-88
 
Reviews
Clinical Review (Can): Marylise Boutros - McGill University
Clinical Review (Can): Andrew Morris/Nisha Thampi - University of Toronto
Clinical Review (US): Celia Divino - Mount Sinai School of Medicine
Methodological Review: Carl Brown - University of British Columbia

January 2014

Topics
1. Clinical Topic: Patients' expectations about effects of chemotherapy for advanced cancer
2. Methodological Topic: Ethics
 
Questions
  1. What is the clinical question being addressed?
  2. Werer the participants relevant to the research question and was their selection well reasoned?
  3. Were the data collection methods appropriate for the research objectives and settings?
  4. Was the data collection comprehensive enough to support the rich and robust descriptions of the observed events?
  5. Were the data appropriately analyzed and the findings adequately corroborated?
  6. How evocative and thorough is the description?
  7. How comprehensive and relevant are the theoretical conclusions?
  8. Does this study help me understand my practice? Does it help me understand my relationship with my patients and their families?
  1. What is the clinical question being addressed?
  2. Were the participants relevant to the research question and was their selection well reasoned?
  3. Were the data collection methods appropriate for the research objectives and settings?
  4. Was the data collection comprehensive enough to support rich and robust descriptions of the observed events?
  5. Were the data appropriately analyzed and the finds adequately corroborated?
  6. How evocative and thorough is the description?
  7. How comprehensive and relevant are the theoretical conclusions?
  8. Does this study help me to understand the context of my practice?
  9. Does the study help me understand my relationships with my patients and their families?
Articles

1. Patients' expectations about effects of chemotherapy for advanced cancer; Weeks JC, Ctalano PJ, Cronin A, et al. Patients' expectations about effects of chemotherapy for advanced cancer. N Engl J Med 2012;367:1616-1625

2. Users' guides to the medical literature XXIII - Qualative research in health care A; Giacomini MK, Cook DJ; for the Evidence-Based Medicine Working Group. Users' guide to the medical literature XXIII. Qualitative research in health care A. Are the results of the study valid? JAMA 2000;284(3):357-362

3. Users' guides to the medical literature XXIII. Qualitative research in health care B.; Giacomini MK, Cook DJ; for the Evidence-Based Medicine Working Group. Users' guides to the medical literature XXIII. Qualitative research in health care B. What are the results and how do they help me care for my patients? JAMA 2000;284(4):478-482
 
Reviews
Clinical Review (Can): Karen Devon - University of Toronto
Clinical Review (Can): Anthony Fields - University of Alberta
Clinical Review (US): Daniel Hinshaw - University of Michigan
Methodological Review: Tim Pawlik - John Hopkins Medical School

December 2013

Topics
1. Clinical Topic: Negative pressure wound therapy
2. Methodological Topic: Meta-analysis - non experimental design
 
Questions
  1. What is the clinical question being addressed?
  2. Did the review explicitly address a sensible clinical question?
  3. Was the search for relevant studies detailed and exhaustive?
  4. Was there a qualitative and/or quantative assessment of hetrogeneity?
  5. Are the interventions adequately described?
  6. Were the clinically important outcomes consdiered?
  7. Was there adequated reporting or results including descriptive information of each study?
  8. Was there an assessment of potential biases?
  9. What are the overall results of the review?
  10. Was there adequate reporting using the Strobe checklist?
  11. Was there a discussion of what future research is required?
  12. State the conclusion. Have the authors the question posed?
  13. Does the evidence support the conclusion?
Articles

1. Negative pressure wound therapy; Roberts DJ, Zygun DA, Grendar J, et al. Negative-pressure wound therapy for critically ill adults with open abdominal wounds; A systematic review. J Trauma Acute Surg 2012;73:629-639

2. Reporting of observational studies in epidemiology; von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemilology (STROBE) statement; guidelines for reporting observational studies. Ann Int Med 2007;147:573-577
 
Reviews
Clinical Review (Can): Neil Parry - University of Western Ontario
Clinical Review (US): Clay Cothren Burlew - University of Colorado
Methodological Review: Harry Henteleff - Dalhousie University

November 2013

Topics
1. Clinical Topic: Effect of three decades of screening mammography on breast cancer incidence
2. Methodological Topic: Administrative Data
 
Questions
  1. What is the clinical question being addressed?
  2. What is the study design? Is it appropriate?
  3. What are the sources of data?
  4. Are the data accurate and valid?
  5. What was the intervention and how was it assessed?
  6. What outcomes were considered?
  7. Are there other clinically important outcomes that should be considered?
  8. How large and precise was the difference in outcomes?
  9. Are there any factors (confounders) that might explain the results?
  10. State the conclusion. Have the authors addressed the clinical question posed?
  11. Does the evidence support the conclusion?
Articles

1. Effect of three decades of screening mamography on breast cancer incidence; Bleyer A, Welch HG. Effect of three decades of screening mammography on breast-cancer incidence. New Engl J Med 2012;367:1998-2005

2. Reader's Guide to Critical Appraisal of Cohort Studies: 1; Rochon PA, Gurwitz JH, Sykora K et al. Readerís guide to critical appraisal of cohort studies: 1. Role and design.  BMJ 2005;330:895-897

3. Reader's Guide to Critical Appraisal of Cohort Studies: 2; Mamdani M, Sykora K, Li P et al. Readerís guide to critical appraisal of cohort studies: 2. Assessing potential for confounding. BMJ 2005;330:960-2

4. Reader's Guide to Critical Appraisal of Cohort Studies: 3; Normand SLT, Sykora K, Li P, et al. Readerís guide to critical appraisal of cohort studies: 3. Analytical strategies to reduce confounding. BMJ 2005;330:1021-3
 
Reviews
Clinical Review (Can): Jean-Francois Boileau - Sherbrooke University
Clinical Review (Can): Heather Bryant - Canadian Partners Against Cancer
Clinical Review (US): Lisa Newman - University of Michigan
Methodological Review: Steve Latosinsky - University of Western Ontario

September 2013

Topics
1. Clinical Topic: Primary anastomosis vs. Hartmann's procedure for perforated lt. sided diverticulitis
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized and concealed?
  3. Were all patients who entered the trial properly accounted for and attributed for at its conclusion?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Were the study patients similar to my patients?
  9. Were the measured outcomes clinically relevant?
  10. Were all clinically important outcomes considered?
  11. Are my surgical skills similar to those of the study surgeons?
  12. State the conclusion. Have the authors addressed the clinical question posed?
  13. Does the evidence support the conclusion?
Articles

1. Primary anastomosis vs. Hartmann's procedure for perforated lt. sided diverticulitis; Oberkoffer CE, Rickenbackher A, Raptis DA, et al. Multicenter randomized clinical trial of primary anastomosis or Hartmann's procedure for perforated left colonic diverticulitis with purulent or fecal peritonitis. Ann Surg 2012;256(6):819-827

2. How to Use an Article Evaluating Surgical Interventions; Urschel JD, Goldsmith CH, Tandan VR, Miller JD; for the Evidence-Based Surgery Working Group.  Users' Guide to Evidence-Based Surgery: How to Use an Article Evaluating Surgical Interventions  CJS 2001; 44(2): 95-100
 
Reviews
Clinical Review (Can): Don Buie - University of Calgary
Clinical Review (US): Charles Heise - University of Wisconsin
Methodological Review: Elijah Dixon - University of Calgary

May 2013

Topics
1. Clinical Topic: Effect of WHO checklist on in-hospital mortality
2. Methodological Topic: Quality Improvement
 
Questions
  1. What is the clinical question being addressed?
  2. What is the study design?
  3. What are the possible biases in a before-after study design?
  4. Comment on the outcomes of the study?
  5. Were the results of the study clinically and statistically significant?
  6. Are the findings in this study generalizable to other institutions?
  7. State the conclusion. Have the authors addressed the clinical question posed?
  8. Dose the evidence support the conclusion?
  9. Based on the evidence from this study, should the checklist be mandatory?
  10. Is further research required?
Articles

1. Effect of WHO checklist on in-hospital mortality;
van Klei WA, Hoff RG, van Aarnhem EEHL, et al. Effects of the introduction of the WHO ďsurgical safety checklistĒ on in-hospital mortality. Ann Surg 2012;255(1):44-49 

2. Reader's Guide to Critical Appraisal of Cohort Studies: 3; Normand SLT, Sykora K, Li P, et al. Readerís guide to critical appraisal of cohort studies: 3. Analytical strategies to reduce confounding. BMJ 2005;330:1021-3
 
Reviews
Clinical Review (Can): John Kortbeek - University of Calgary
Clinical Review (US): Caprice Greenberg - University of Wisconsi Madison
Methodological Review: Tara Mastracci - Cleveland Clinic

April 2013

Topics
1. Clinical Topic: Impact of 80-hour work week on mortality and morbidity
2. Methodological Topic: Administrative Data
 
Questions
  1. What is the clinica question being addressed?
  2. What is the study design? Is it appropriate?
  3. What are the sources of data?
  4. Are the data accurate and valid?
  5. What was the intervention and how was it assessed?
  6. What outcomes were considered?
  7. Are there other clinically important outcomes that should be considered?
  8. How large and precise was the difference in the outcome?
  9. Are there any factors (confounders) that might explain the differences in the results?
  10. State the conclusion. Have the authors addressed the clinical question posed?
  11. Does the evidence support the conclusion?
  12. Should the results of this study lead to changes related to the 80 work week?
Articles

1. Impact of 80-hour work week on mortality and morbidity;
Morrison AC, Wyatt MM, Carrick MM. Impact of the 80-hour work week on mortality and morbidity in trauma patients: an analysis of the national trauma data bank. J Surg Res 2009;154:157-62 

2. Reader's Guide to Critical Appraisal of Cohort Studies: 1; Rochon PA, Gurwitz JH, Sykora K et al. Readerís guide to critical appraisal of cohort studies: 1. Role and design.  BMJ 2005;330:895-897

3. Reader's Guide to Critical Appraisal of Cohort Studies: 2; Mamdani M, Sykora K, Li P et al. Readerís guide to critical appraisal of cohort studies: 2. Assessing potential for confounding. BMJ 2005;330:960-2
 
Reviews
Clinical Review (Can): Paola Fata - McGill Unviersity
Clinical Review (US): Timothy Flynn - University of Florida College of Medicine
Methodological Review: Karen Brasel - Medical College of Wisconsin

March 2013

Topics
1. Clinical Topic: Cost effectiveness of bariatric surgery for severly obese diabetics
2. Methodological Topic: Economic Analysis
 
Questions
  1. What is the clinical quesion being addressed?
  2. Did the analysis provide a full economic comparison of health care strategies?
  3. Was a broad enough viewpoint adopted?
  4. Were all the relevant clinical strategies compared?
  5. Was clinical effectiveness established?
  6. Were costs measured accurately?
  7. Were data on costs and outcomes appropriately integrated?
  8. Was appropriate allowance made for uncertainties in the analysis?
  9. What were the incremental costs and outcomes of each strategy?
  10. Do incremental costs and outcomes differ between subgroups?
  11. State the conclusion. Have the authors adressed the clinical question posed?
  12. Does the evidence support the conclusion?
Articles

1. Cost effectiveness of bariatric surgery for severly obese diabetics;
Horerger TJ, Zhang P, Segel JE, et al. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Diabetes Care 2010;33:1933-39 

2. How to use an article on economic analysis; Thoma A, Sprague S, Tandan V; for the Evidence-Based Surgery Working Group Usersí Guide to the Surgical Literature: How to Use an Article on Economic Analysis. CJS 2001;44(5):347-54
 
Reviews
Clinical Review (Can): Dan Birch - University of Alberta
Clinical Review (US): Peter Hallowell - University of Virginia
Methodological Review: Harry Henteleff - Dalhousie University

February 2013

Topics
1. Clinical Topic: Use of MRI to identify good prognosis in stage I, II, III rectal cancer
2. Methodological Topic: Prognosis/Natural History
 
Questions
  1. What is the clinical question being addressed?
  2. Was there a representative and well-defined sample of patients at a similar point in the course of the disease?
  3. Was follow-up suffieciently long and complete?
  4. Were objective and unbiased outcome criteria used?
  5. Was there adjustment for important prognostic factors?
  6. How large is the likelihood of the outcome event(s) in a specified period of time? How precise are the estimates of liklihood?
  7. Will the results help me in caring form my patients?
  8. Will the results lead directly to selecting or avoiding therapy?
  9. Are the results useful for reassuring or counseling patients?
  10. State the conclusion. Have the authors addressed the clinical question posed?
  11. Does the evidence supoort the conclusion?
Articles

1. Use of MRI to identify good prognosis in stage I, II, III rectal cancer;
Taylor FGM, Quirke P, Heald RJ, et al. Preoperative high Ėresolution magnetic resonance imaging can identify good prognosis stage I, II and III rectal cancer best managed by surgery alone. Ann Surg 2011;253:711-719 

2. How to use an article about prognosis - surg literature;
Hansebout RR, Cornacchi SD, Haines T, et al; for the Evidence-Based Surgery Working Group. Usersí guide to the surgical literature. How to use an article about prognosis. Can J Surg 2009;52(4):328-36
 
Reviews
Clinical Review (Can): Erin Kennedy - University of Toronto
Clinical Review (Can): Blair Macdonald - University of Ottawa
Clinical Review (US): Heidi Nelson - Mayo Clinic Rochester
Methodological Review: Arden Morris - University of Michigan

January 2013

Topics
1. Clinical Topic: Effect of stitch length on wound complications
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized and concealed?
  3. Were all patients who entered into the trial properly accounted for and attributed for at its conclusion?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. Were the measured outcomes clinically relevant?
  8. How large and precise was the treatment effect?
  9. Were the study patients similar to your patients?
  10. Are your surgical skill similar to those of the study surgeons?
  11. State the conclusion. Have the authors addressed the clinical question posed?
  12. Does the evidence support the concoulsion?
Articles

1. Effect of stitch length on wound complications;
Millbourn D, Cengiz Y, Israelsson LA. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg 2009;144(11):1056-59 

2. How to Use an Article Evaluating Surgical Interventions; Urschel JD, Goldsmith CH, Tandan VR, Miller JD; for the Evidence-Based Surgery Working Group.  Users' Guide to Evidence-Based Surgery: How to Use an Article Evaluating Surgical Interventions  CJS 2001; 44(2): 95-100
 
Reviews
Clinical Review (Can): Ori Rotstein - University of Toronto
Clinical Review (Can): Fred Brenneman - University of Toronto
Clinical Review (US): Parag Bhanot - Georgetown University
Methodological Review: Robin McLeod - University of Toronto

December 2012

Topics
1. Clinical Topic: Screening for breast cancer: U.S. Preventive Task Force recommendation statement
2. Methodological Topic: Guidelines
 
Questions
  1. What are the clinical questions being asked?
  2. Were all important options and outcomes considered?
  3. Was an explicit and sensible process used to identify, select and combine evidence?
  4. Was an explicit and sensible process used to consider the relative value of differenct outcomes?
  5. Is the guideline likely to account for important recent developments?
  6. Has the guideline been subjected to peer review and testing?
  7. Are practical clinically important recommendations made?
  8. How strong are the recommendations?
  9. What is the impact of uncertainty associated with the evidnece and values used in the guidelines?
  10. State the concluison. Have authors addressed the clinical questions posed?
  11. Does the evidence support the concluison?
Articles

1. Screening for breast cancer: U.S. Preventive Task Force recommendation statement;
U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Task Force recommendation statement Ann Int Med 2009;151:716-26 

2. How to use clinical practice guidelines (a); Hayward RSA, Wilson MC, Tunis SR, Bass EB, Guyatt G, for the Evidence-Based Medicine Working Group. Users' Guide to the Medical Literature. VIII How to use Clinical Practice Guidelines. JAMA 1995;274(7):570-74

3. How to use clinical practice guidelines (b); Wilson MC, Hayward RSA, Tunis SR, Bass EB, Guyatt G, for the Evidence-Based Medicine Working Group.  Users' Guide to the Medical Literature. VIII How to Use Clinical Practice Guidelines.  JAMA 1995;274(20):1630-32
 
Reviews
Clinical Review (Can): Ralph George - University of Toronto
Clinical Review (US): Hiram Cody III - Memorial Sloan-Kettering Cancer Center
Methodological Review: Steve Latosinsky - University of Western Ontario

November 2012

Topics
1. Clinical Topic: Implementation of a medical team training program and the effect on surgical mortality
2. Methodological Topic: Quality Improvement
 
Questions
  1. What is the clinical question being addressed?
  2. What is the study design?
  3. Was the intervention adequately described?
  4. What is the data source?
  5. Are the data accurate and valid?
  6. Is the matching appropriate and are the 2 groups similar?
  7. Were the results clinically and statistically significant?
  8. Are the findings in this study generalizable to other institutions?
  9. Identify biases that might account for differences in the conclusions.
  10. State the conclusion. Have the authors addressed the clinical question posed?
  11. Does the evidence support the conclusion?
  12. Are further studies required?
Articles

1. Implementing a medical team buidling program and the effects on surgical mortality;
Neily J, Mills PD, Young-Xu Y, et al. Association between implementation of a medical team training program and surgical mortality. JAMA 2010;304(15):1693-1700 

2. Estimating Causal Effects from Large Data Sets Using Propensity Scores; Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med 1997;127:757-63

3. Propensity score matching;
Propensity Score Matching Wikipedia, the free encyclopedia      http://en.wikipedia.org/wiki/Propensity_score_matching (click here for link)

4. Propensity score matching;
 
Reviews
Clinical Review (Can): David Urbach - University of Toronto
Clinical Review (US): Amy Halverson - Northwestern University
Methodological Review: Timothy Pawlik - John Hopkins University School of Medicine

October 2012

Topics
1. Clinical Topic: Antibiotics vs. Surgery in acute appendicitis
2. Methodological Topic: Meta-analysis
 
Questions
  1. What are the clinical questions being addressed? Were the questions the same in both studies?
  2. Did the reviews explicityl address a sensible clinical question?
  3. Were the searches for relevant studies detailed and exhaustive?
  4. Were the primary studies of high methodologic quality?
  5. Were assessments of studies reproducible?
  6. How did the results differ between the two studies?
  7. What are the overall results of the reviews?
  8. How precise were the results?
  9. Were clinically important outcomes considered in both analyses?
  10. State the conclusion. Have the authors addressed the clinical question posed?
  11. What are the limitations of the two studies?
Articles

1. Use of antibiotics only for treatment of uncomplicated appendicitis;
Liu K, Fogg L. Use of antibiotics alone for treatment of uncomplicated acute appendicitis: a systematic review and meta-analysis. Surgery 2011;150:673-83 

2. Surgery vs. antibiotic treatment in acute appendicitis;
Ansaloni L, Catena F, Coccolini F et al. Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials 

3. How to use an article on a systematic review and meta-analysis; Bhandari M, Devereaux PJ, Montore V, et al; for the Evidence Based Surgery Working Group. Usersí Guide to Surgical Literature: How to Use a Systematic Review and Meta-analysis. CJS 2004; 47(1): 60-67 
 
Reviews
Clinical Review (Can): Darrell Boone - Memorial University
Clinical Review (US): Rodney Mason - University of Southern California
Methodological Review: Lillian Kao - University of Texas HSC

May 2012

Topics
1. Clinical Topic: Use of MRI in Breast Cancer
2. Methodological Topic: Diagnostic Tests
 
Questions
  1. What is the clinical question being addressed?
  2. What is the rationale for the study?
  3. What is the study design?
  4. Was the assignment of patients to treatment randomized?
  5. Were all  the patients who entered into the trial properly accounted for and attributed at its conclusion?
  6. Did the sample include an appropriate spectrum of patients and were groups similar at baseline?
  7. Were the methods for performing the test described in suffficent detail to premit replication?
  8. Aside from the experimental intervention, were the groups treated equally?
  9. Were all clinically important outcomes considered?
  10. How large and precise was the treatment effect?
  11. Are the likely benefits worth the potential harm and costs?
  12. Will the reproducibilty of the test result and its interpretations be satisfactory in my setting?
  13. State the conclusion. Have the authors addressed the clinical question posed?
  14. Does the evidence support the conclusion?
Articles

1. Use of MRI in Breast Cancer; Turnbull L, Brown S, Harvey I, et al. Comparative effectiveness of MRI in breast cancer (COMICE) Trial: a randomized controlled trial. Lancet 2010;375:563-71

2. How to Use an Article About a Diagnostic Test; Archibald S, Bhandari M, Thoma A, for the Evidence-Based Surgery Working Group. Usersí Guides to the Surgical Literature: How to Use an Article about a Diagnostic Test. CJS 2001;44(1):17-23
 
Reviews
Clinical Review (Can): May-Lynn Quan - University of Calgary
Clinical Review (US): Kelly Hunt - University of Texas MD Anderson Cancer Center
Methodological Review: Harry Henteleff - Dalhousie University

April 2012

Topics
1. Clinical Topic: CRASH-2 Trial
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clincial question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all the patients who entered the trial properly accouted for and attributed at tis conclusions?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental interventions, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Were all clinically important outcomes considered?
  9. Are the likely treatment benefits worth the potential harm and costs?
  10. State the conclusion. Have the authors addressed the clinical question posed?
  11. Does the evidence support the conclusion?
Articles

1. CRASH-2 Trial; CRASH-S Trial Collaborators. Effects of tranexamic acid on death, vascular occlusive events and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomized placebo-controlled trial. Lancet 2010;376:23-32

2. How to Use an Article About Therapy or Prevention (a); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1993 Dec 1; 270(21): 2598-2601

3. How to Use an Article About Therapy or Prevention (b); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1994 Jan 5; 271(1): 59-63
 
Reviews
Clinical Review (Can): Mary vanWijngaarden-Stephens - University of Alberta
Clinical Review (US): John Holcomb - University of Texas Houston
Methodological Review: Andrew Kirkpatrick - University of Calgary
Methodological Review: Russell Gruen - Melbourne Australia

March 2012

Topics
1. Clinical Topic: Effect of Blood Loss on Outcome in 30-Day Mortality
2. Methodological Topic: Propensity Scores
 
Questions
  1. What is the clinical question being addressed?
  2. What is the study design?
  3. What is the source of data?
  4. Are the data accurate and valid?
  5. Is the matching appropriate and are the 2 groups similar?
  6. Identify potential biases that might account for differences in the conclusions?
  7. What outcomes were assessed and are they clinically relevant and sensitive?
  8. Are the differences clinically significant?
  9. Are further studies required?
  10. State the conclusion. Have the authors addressed the clinical question posed?
  11. Do the data support the conclusion?
Articles

1. Effect of Blood Loss on Outcome in 30-Day Mortality; Wu WC, Smith TS, Henderson WG, et al. Operative blood loss, blood transfusion and 30-day mortality in older patients after major non cardiac surgery. Ann Surg 2010;252(1):11-17

2. Estimating Causal Effects from Large Data Sets Using Propensity Scores; Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med 1997;127:757-63
 
Reviews
Clinical Review (Can): Sandro Rizoli - University of Toronto
Clinical Review (Can): Mo Bhandari/Raman Mundi - McMaster University
Clinical Review (US): Martin Schreiber - Oregon Health Science University
Methodological Review: Tara Mastracci - Cleveland Clinic

February 2012

Topics
1. Clinical Topic: Long-term Effect of ASA on Colorectal Cancer
2. Methodological Topic: Meta-analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Did the review explicitly address a sensible clinical question?
  3. Was the search for relevant studies detailed and exhaustive?
  4. Were the primary studies of high methodologic quality?
  5. Were assessments of studies reproducible?
  6. Were the results similar from study to study?
  7. What are the overall results of the review?
  8. How precise were the resutls?
  9. Were the clinically important outcomes considered?
  10. State the conclusion. Have the authors addressed the clinical question posed?
  11. Does the evidence support the conclusion?
Articles

1. Long-term Effect of ASA on Colorectal Cancer; Rothwell PM, Wilson M, elwin CE, et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomized trials. Lancet 2010;376:1741-50

2. How to Use an Article on a Systematic Review and Meta-analysis; Bhandari M, Devereaux PJ, Montore V, et al; for the Evidence Based Surgery Working Group. Usersí Guide to Surgical Literature: How to Use a Systematic Review and Meta-analysis. CJS 2004; 47(1): 60-67 
 
Reviews
Clinical Review (Can): Steve Gallinger - University of Toronto
Clinical Review (US): James Church - Cleveland Clinic
Methodological Review: Carl Brown - University of British Columbia

January 2012

Topics
1. Clinical Topic: Sleep Deprivation in Surgeons
2. Methodological Topic: Administrative Data
 
Questions
  1. What is the clinical question being addressed?
  2. What is the study design?
  3. What is the source of data?
  4. Are the data accurate and valid?
  5. Are the 2 cohorts adequately matched?
  6. What outcomes were assessed and are they clinically relevant and sensitive?
  7. What are the potential biases?
  8. How precise is the estimate of risk?
  9. What are the results?
  10. Should the results of this study be used to implement etc. or are further studies required?
  11. State the conclusion. Have the authors addressed the clinical question posed?
  12. Does the evidence suppoprt the concluison?
Articles

1. Sleep Deprivation in Surgeons; Rothschild JM, Keohane CA, Rogers S, et al. Risks of complications by attending physicians after performing nighttime procedures. JAMA 2009;302(14):1565-72

2. Reader's Guide to Critical Appraisal of Cohort Studies: 1; Rochon PA, Gurwitz JH, Sykora K et al. Readerís guide to critical appraisal of cohort studies: 1. Role and design.  BMJ 2005;330:895-897

3. Reader's Guide to Critical Appraisal of Cohort Studies: 2; Mamdani M, Sykora K, Li P et al. Readerís guide to critical appraisal of cohort studies: 2. Assessing potential for confounding. BMJ 2005;330:960-2

4. Reader's Guide to Critical Appraisal of Cohort Studies: 3; Normand SLT, Sykora K, Li P, et al. Readerís guide to critical appraisal of cohort studies: 3. Analytical strategies to reduce confounding. BMJ 2005;330:1021-3
 
Reviews
Clinical Review (Can): Garth Warnock - University of British Columbia
Clinical Review (US): Thomas Whalen - Lehigh Valley Health Network
Methodological Review: Prosanto Chaudhury - McGill University

January 2012

Topics
1. Clinical Topic: Early vs. Delayed Cholecystectomy for Acute Cholecystitis
2. Methodological Topic: Economic Analysis
 
Questions
  1. What is the clinical quetion being addressed?
  2. Did the analysis provide a full economic comparison of health care strategies?
  3. Was a broad enough viewpoint adopted?
  4. Were all the relevant clinical strategies compared?
  5. Was clinical effectiveness established?
  6. Were costs measured accurately?
  7. Were data on costs and outcomes appropriately integrated?
  8. Was appropriate allowance made for uncertanties in the analysis?
  9. What were the incremental costs and outcomes of each strategy?
  10. Do incremental costs and outcomes differ between subgroups?
  11. State the conclusion. Have the authors addressed the clinical question posed?
  12. Does the evidence support the conclusion?
Articles

1. Early vs. Delayed Cholecystectomy for Acute Cholecystitis; Wilson E, Gurusamy K, Gluud C et al. Cost-utility and value-of-information analysis of early versus delayed laparoscopic choleystectomy for acute cholecystitis. Br J Surg 2010;97:210-19

2. How to Use an Article on Economic Analysis; Thoma A, Sprague S, Tandan V; for the Evidence-Based Surgery Working Group Usersí Guide to the Surgical Literature: How to Use an Article on Economic Analysis. CJS 2001;44(5):347-54
 
Reviews
Clinical Review (Can): Gabriela Ghitulescu - McGill University
Clinical Review (US): Dennis Fowler - Columbia Universtiy
Methodological Review: Elijah Dixon - University of Calgary

November 2011

Topics
1. Clinical Topic: Electronic Snyoptic OR Reports
2. Methodological Topic: Quality Improvement
 
Questions
1.    What is the clinical question being addressed?
2.    What is the study design?
3.    What is the source of the data?
4.    Comment on the whether this study assessed:
        a.    Accuracy
        b.    Reliability
        c.    Validity
        d.     Completeness of OR reports
5.    Are the results generalizable?
6.    State the conclusion. Have the authors addressed the clinical question posed?
7.    Does the evidence support the conclusion?
Articles

1. Electronic Synoptic OR Reports; Park J, Pillarisetty VG, Brennan MF et al. Electronic synoptic operative reporting: assessing the reliability and completeness of synoptic reports for pancreatic resection. J Am Coll Surg 2010;211:308-15

2. Tips for Learners of Evidence-Based Medicine. 3. Measures of Observer Variability; McGinn T, Wyer PC, Newman TB, et al for the Evidence-Based Medicine Teaching Tips Working Group. Tips for learners of evidence0-based medicine: 3. Measures of observer variability (kappa statistic)
 
Reviews
Clinical Review (Can): Walley Temple/Lloyd Mack - University of Calgary
Clinical Review (US): David Mahvi - Northwestern University
Methodological Review: Karen Brasel - Medical College of Wisconsin

October 2011

Topics
1. Clinical Topic: Need for ALND After Postivie SLNB
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusion?  
  4.  Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?    
  6. Were the surgical techniques adequately described?
  7. Was the expertise of the surgeons entering patients into the trial adequately described?
  8. Aside from the experimental intervention, were the groups treated equally?
  9. How large and precise was the treatment effect?
  10. Were all clinically important outcomes considered?
  11. State the conclusion. Have the authors addressed the clinical question posed?
  12. Does the evidence support the conclusion?
Articles

1. Need for ALND After Positive SLNB; Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs. no axillary dissection in women with invasive breast cancer and sentinel node metastasis. A randomized controlled trial. JAMA 2011;305(6):569-75

2. How to Use an Article Evaluating Surgical Interventions; Urschel JD, Goldsmith CH, Tandan VR, Miller JD; for the Evidence-Based Surgery Working Group.  Users' Guide to Evidence-Based Surgery: How to Use an Article Evaluating Surgical Interventions  CJS 2001; 44(2): 95-100
 
Reviews
Clinical Review (Can): Ralph George - University of Toronto
Clinical Review (Can): Ivo Olivotto/Tanya Berrang - University of British Columbia
Clinical Review (US): Thomas Julian/Kathleen Erb - Drexel University
Methodological Review: Steve Latosinsky - University of Western Ontario/Suzanne Cutter-Los Angeles, CA

May 2011

Topics
1. Clinical Topic: Access to Surgery - Canada /USA
2. Methodological Topic: Administrative Data
 
Questions
  1. What is the clinical question being addressed?
  2. What are the sources of data?
  3. Are the data accurate and valid?
  4. What medical services were assessed? How were they ascertained?
  5. Are the differences in the rates of use of medical services clinically significant?
  6. Are there any factors that might explain the differences in use of medical services?
  7. State the conclusion. Have the authors addressed the question?
  8.  Does the evidence support the conclusion?
  9. Can these data be used to implement changes in health care provision and if so, how? 
Articles

1. Access to Emergency Care - Canada/USA; Krajewski SA, Hameed MA, Smink DS, et al; Access to Emergency Operative Care: A Comparative Study Between the Canadian and American Health Care Systems. Surgery 2009;146(2):300-7

2. Small-Area variations: what are they and what do they mean?; Health Services Research Group. Small-Area Variations: What are They and What do They Mean?  CMAJ. 1992;146(4):467-70
 
Reviews
Clinical Review (Can): Mark C. Taylor - University of Toronto
Clinical Review (Can): Samuel R. Finlayson - Dartmouth Medical School
Methodological Review: Carl J. Brown - University of British Columbia

April 2011

Topics
1. Clinical Topic: Treatment Options for Graves Disease
2. Methodological Topic: Economic Analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Did the analysis provide a full economic comparison of health care strategies?
  3. Was a broad enough viewpoint adopted?
  4. Were all the relevant clinical strategies compared?
  5. Was clinical effectiveness established?
  6. Were costs measured accurately?
  7. Were data on costs and outcomes appropriately integrated?
  8. Was appropriate allowance made for uncertainties in the analysis?
  9. What were the incremental costs and outcomes of each strategy?
  10. Do incremental costs and outcomes differ between subgroups?
  11. State the conclusion. Have the authors addressed the clinical question posed?
  12. Does the evidence support the conclusion?
Articles

1. Treatment Options for Graves Disease; In, H, Pearce EN, Wong AK, et al; Treatment Options for Graveís Disease: A Cost-Effectiveness Analysis. J Am Coll Surg 2009;209(2):170-79

2. How to use an article on economic analysis; Thoma A, Sprague S, Tandan V; for the Evidence-Based Surgery Working Group Usersí Guide to the Surgical Literature: How to Use an Article on Economic Analysis. CJS 2001;44(5):347-54
 
Reviews
Clinical Review (Can): Janice L. Paseika - University of Calgary
Clinical Review (US): Peter Angelos - University of Chicago
Methodological Review: Prosanto Chaudhury - McGill University

March 2011

Topics
1. Clinical Topic: Guidelines for Barrett's Esophagus with High Grade Dysplasia
2. Methodological Topic: Guidelines
 
Questions
  1. What are the clinical questions being asked?
  2. Were all important options and outcomes considered?
  3. Was an explicit and sensible process used to identify, select and combine evidence?
  4. Was an explicit and sensible process used to consider the relative value of different outcomes?
  5. Is the guideline likely to account for important recent developments? Has the guideline been subjected to peer review and testing?
  6. Are practical clinically important recommendations made?
  7. How strong are the recommendations?
  8. What is the impact of uncertainty associated with the evidence and values used in the guidelines?
  9. State the conclusion. Have the authors addressed the clinical questions posed?
  10. Does the evidence support the conclusion?
Articles

1. Guidelines for Barrett's Esophagus with High Grade Dysplasia; Fernando HC, Murthy SC, Hofstetter W et al; The Society of Thoracic Surgeons Practice Guideline Series: Guidelines for the Management of Barrettís Esophagus with High-Grade Dysplasia. Ann Thorac Surg 2009;87:1993-2002

2. How to use clinical practice guidelines (a); Hayward RSA, Wilson MC, Tunis SR, Bass EB, Guyatt G, for the Evidence-Based Medicine Working Group. Users' Guide to the Medical Literature. VIII How to use Clinical Practice Guidelines. JAMA 1995;274(7):570-74

3. How to use clinical practice guidelines (b); Wilson MC, Hayward RSA, Tunis SR, Bass EB, Guyatt G, for the Evidence-Based Medicine Working Group.  Users' Guide to the Medical Literature. VIII How to Use Clinical Practice Guidelines.  JAMA 1995;274(20):1630-32
 
Reviews
Clinical Review (Can): James C. Ellsmere - Dalhousie University
Clinical Review (US): Nabil Rizk - Memorial Sloan-Kettering Cancer Center
Methodological Review: Harry J. Henteleff - Dalhousie University

February 2011

Topics
1. Clinical Topic: Cancer Risk Reduction Strategies for BRCA1/2
2. Methodological Topic: Decision Analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Were all of the realistic clinical strategies compared?
  3. Were all clinically relevant outcomes considered?
  4. Was an explicit and sensible process used to identify, select and combine the evidence into probabilities?
  5. Were the utilities obtained in an explicit and sensible way from credible sources?
  6. Was the potential impact of any uncertainty in the evidence determined in the baseline analysis?
  7. Does one strategy result in a clinically important gain for patients?
  8. How strong is the evidence used in the analysis?
  9. Could the uncertainty in the evidence change the results?
  10. State the conclusion.  Have the authors addressed the clinical question posed?
  11. Does the evidence support the conclusion?        
Articles

1. Cancer Risk Reduction Strategies for BRCA1/2; Kurian AW, Sigal BM, Plevritis SK; Survival Analysis of Cancer Risk Reduction Strategies for BRCA1/2 Mutation Carriers. J Clin Oncol 2009;22:1-10

2. How to use an clinical decision analysis (a); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group.  Users' Guides to the Medical Literature.  VII. How to Use a Clinical Decision Analysis.  JAMA 1995; 273(16): 1292-1295

3. How to use a clinical decision analysis (b); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group.  Users' Guides to the Medical Literature.  VII. How to Use a Clinical Decision Analysis.  JAMA 1995; 273(20): 1610-1613
 
Reviews
Clinical Review (Can): Rona E. Cheifetz - University of British Columbia
Clinical Review (US): Lee G. Wilke - University of WisconsinĖMadison
Methodological Review: Steven Latosinsky - University of Western Ontario

January 2011

Topics
1. Clinical Topic: Smoking Cessation Preoperatively
2. Methodological Topic: Meta-analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Did the review explicitly address a sensible clinical question?
  3. Was the search for relevant studies detailed and exhaustive?
  4. Were the primary studies of high methodologic quality?
  5. Were assessments of studies reproducible?
  6. Were the results similar from study to study?
  7. What are the overall results of the review?
  8. How precise were the results?
  9. Were the clinically important outcomes considered?
  10. State the conclusion.  Have the authors addressed the clinical question posed?
  11. Does the evidence support the conclusion?         
Articles

1. Smoking Cessation Preoperatively; Thomsen T, TÝnnesen H, MÝller AM; Effect of Preoperative Smoking Cessation Interventions on Posteroperative Complications and Smoking Cessation. Br J Surg. 2009;96:451-61

2. How to use an article on a systematic review and meta-analysis; Bhandari M, Devereaux PJ, Montore V, et al; for the Evidence Based Surgery Working Group. Usersí Guide to Surgical Literature: How to Use a Systematic Review and Meta-analysis. CJS 2004; 47(1): 60-67 
 
Reviews
Clinical Review (Can): Richard J. Finley - University of British Columbia
Clinical Review (Can): Franco Carli; Salvatore Muccio - McGill University
Clinical Review (US): David O. Warner - Mayo Clinic
Methodological Review: Tara M. Mastracci - Cleveland Clinic

December 2010

Topics
1. Clinical Topic: Surgical Outcomes in July
2. Methodological Topic: Bias
 
Questions
  1. What is the clinical question being asked in these two studies?
  2. What are the study designs of the two studies?
  3. What are the sources of data used?
  4. Identify potential biases that might account for differences in the conclusions?
  5. What was the outcome assessed and is it clinically relevant and sensitive?
  6. Comment on the results of the studies.
  7. State the conclusion of the studies. 
  8. Do the data support the conclusion?       
Articles

1. Surgical Outcomes in July; Inaba K, Recinos G, Teixeria PGR, et al; Complications and Death at the Start of the New Academic Year: Is There a July Phenomenon? J of Trauma 2010;68(1):19-22

2. Surgical Outcomes in July -2; Englesbe MJ, Fan Z, Baser O et al; Mortality in Medicare Patients Undergoing Surgery in July in Teaching Hospitals. Ann of Surg. 2009;249(6):871-76

3. Bias in Surgical Research; Paradis C; Bias in Surgical Research. Ann of Surg. 2008;248(2):180-88
 
Reviews
Clinical Review (Can): S. Morad Hameed - University of British Columbia
Clinical Review (US): Jacob Greenberg; Stanley W. Ashley - Brigham and Womenís Hospital
Methodological Review: Karen J. Brasel - Medical College of Wisconsin

November 2010

Topics
1. Clinical Topic: Hyperoxygenation to Prevent SSI
2. Methodological Topic: Number Needed to Treat/Confidence Intervals/Equivalence
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusions?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. State the estimates upon which the sample size was calculated. In retrospect, were they accurate?
  9. Is there adequate power to conclude the risk of a SSI is the same if 80% or 30% oxygen is administered?
  10. Were all clinically important outcomes considered?
  11. State the conclusion.  Have the authors addressed the clinical question posed?
  12. Does the evidence support the conclusion?                
Articles

1. Hyperoxygenation to prevent SSI; Meyhoff CS, Wtterslev J, Jorgensen LN, et al; Effect of High Perioperative Oxygen Fraction on Surgical Site Infection and Pulmonary Complication after Abdominal Surgery. PROXI Randomized Clinical Trial. JAMA 2009;302(14):1543-50

2. Tips for Learners; Measures of Precision (Confidience Intervals); Montori VM, Kleinbart J, Newman TB et al; Tips for Learners of Evidence-Based Medicine: 2 Measures of Precision (Confidence Intervals). Can Med Assoc J 2004;171(6):611-15
 
Reviews
Clinical Review (Can): Stuart A. McCluskey - University of Toronto
Clinical Review (Can): Giuseppe Papia - University of Toronto
Clinical Review (US): Hiram C. Polk; Ozan Akca; Motaz Qadan - University of Louisville
Methodological Review: Andrew W. Kirkpatrick - University of Calgary

October 2010

Topics
1. Clinical Topic: Skin Preparation in the OR
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to reatment randomized?
  3. Were all of the patients who entered the trial properly accounted for and attributed at its conclusion?
  4. Were patients, their clinicians and study peronnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Were all clinically important outcomes considered?
  9. State the conclusion. Have the authors addressed the clinical question posed?
  10. Does the evidence support the conclusion?
Articles

1. Skin Preparation in the OR; Darouiche RO, Wall MJ, Itani KMF et al; Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical Site Antisepsis. New Eng J Med 2010;362(1):18-26

2. How to use an article about therapy or prevention (a); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1993 Dec 1; 270(21): 2598-2601

3. How to use an article about therapy or prevention (b); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1994 Jan 5; 271(1): 59-63
 
Reviews
Clinical Review (Can): Rachel G. Khadaroo - University of Alberta
Clinical Review (US): William G. Cheadle - University of Louisville
Methodological Review: Elijah Dixon - University of Calgary

May 2010

Topics
1. Clinical Topic: MRSA Screening in Surgical Patients
2. Methodological Topic: Screening
 
Questions
  1. What is the clinical quetion being addressed?
  2. Is the condition a significant health problem?
  3. Is the screening test simple and safe and validated as a screening test?
  4. Is the screening program well described including testing, diagnosis and treatment and administrative and quality assurance considered?
  5. Does early detection lead to an improved outcome?
  6. Does screening outweigh the physical and psychological harm?
  7. Is the study design adequate to address the clinical question?
  8. Are the outcomes clinically relevant?
  9. What are the results?
  10. Are the results generalizable?
  11. State the conclusion. Have the authors addressed the clinical question posed?
  12. Will the results of this study be useful in changing your practice?
  13. Does the evidence support the conclusion?
Articles

1. MRSA Screening in Surgical Patients; Harbarth S, Frankhauser C, Schrenzel J, et al. Universal Methicillin-resistant Staphylococcus Aureus at Hospital Admission and Nosocomial Infection in Surgical Patients. JAMA 2008;299(10):1149-57

2. Screening - Wikipedia; Screening (medicine). Wikipedia, the free encyclopedia
 
Reviews
Clinical Review (Can): Stewart Hamilton - University of Alberta
Clinical Review (US): Phil Barie - Weill Cornell Medical College
Methodological Review: Harry Henteleff - Dalhousie University

April 2010

Topics
1. Clinical Topic: Use of Hydrocortisone in Septic Shock
2. Methodological Topic: Number Needed to Treat/Confidence Intervals/Equivalence
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusion?
  4. Were patients, their clinicians and study personnel "blind' to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental interevention, werer the groups teated equally?
  7. How large and precise was the treatment effect?
  8. Can the results be applied to my patient care?
  9. Were all clinically important outcomes considered?
  10. Are the likely treatment benefits worth the potential harm and costs?
  11. State the conclusion. Have the authors addressed the clinical question posed?
  12. Does the evidence support the conclusion?
Articles

1. Use of Hydrocortisone in Septic Shock; Sprung CL, Annane D, Keh D, et al. Hydrocortison Therapy for Patients with Septic Shock. N Engl J Med 2008;358(2):111-24

2. How to Use an Article About Therapy or Prevention (a); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1993 Dec 1; 270(21): 2598-2601

3. How to Use an Article About Therapy or Prevention (b); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1994 Jan 5; 271(1): 59-63
 
Reviews
Clinical Review (Can): John Marshall - University of Toronto
Clinical Review (US): Joseph Solomkin - Uinversity of Cincinnati
Methodological Review: Prosanto Chaudhury - McGill University

March 2010

Topics
1. Clinical Topic: Use of Beta-Blockers in Patients Undergoing Non-cardiac Surgery
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusion?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Can the results be applied to my patient care?
  9. Were all clinically important outcomes consdiered?
  10. Are the likely treatment benefits worth the potential harm and costs?
  11. State the conclusion. Have the authors addressed the clinical question posed?
  12. Does the evidence support the conclusion?
Articles

1. Use of Beta-blockers in Patients Undergoing Non-cardiac Surgery; POISE Study Group Devereaux PJ, Yang H, Yusuf S, et al. Effects of Extended-release Metoprolol Succicante in Patients Undergoing Non-cardiac Surgery (POISE trial): A Randomized Controlled Trial. Lancet 2008;371(9627):1839-47

2. How to Use an Article About Therapy or Prevention (a); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1993 Dec 1; 270(21): 2598-2601

3. How to Use an Article About Therapy or Prevention (b); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1994 Jan 5; 271(1): 59-63
 
Reviews
Clinical Review (Can): Richard MacLean - McMaster University
Clinical Review (Can): Mary-Anne Aarts - University of Toronto
Clinical Review (US): Santiago Garcia & Edward McFalls - University of Minnesota
Clinical Review (US): Stephen Cassivi - Mayo Clinic
Methodological Review: Tara Mastracci - Cleveland Clinic

February 2010

Topics
1. Clinical Topic: Management of Pilonidal Sinus
2. Methodological Topic: Meta-analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Did the review explicity address a sensible clinical question?
  3. Was the search for relevant studies detailed and exhaustive?
  4. Were the primary studies of high methodological quality?
  5. Were assessments of studies reproducible?
  6. Were the results similar from study to study?
  7. What are the overall results of the review?
  8. How percise were the results?
  9. Were the clinically important outcomes considered?
  10. Are the benefits worth the costs and potential risks?
  11. State the conclusion. have the authors addressed the clinical question posed?
  12. Does the evidence support the conclusion?
Articles

1. Management of Pilonidal Sinus; McCallum IJD, King PM, Bruce J. Healing by Primary Closure versus Open Healing After Surgery for Pilonidal Sinus: Systematic Review and Meta-analysis. BMJ 2008;336(7649):868-71

2. How to Use a Systematic Review and Meta-analysis; Bhandari M, Devereaux PJ, Montore V, et al; for the Evidence-Based Surgery Working Group. Users' Guide to Surgical Literature: How to Use a Systematic Review and Meta-analysis. Can J Surg 2004;47(1):60-67
 
Reviews
Clinical Review (Can): Carol-Ann Vasilevsky - McGill University
Clinical Review (US): Lester Gottesman - Columbia University
Methodological Review: Karen Brasel - Medical College of Wisconsin

January 2010

Topics
1. Clinical Topic: Nut, Corn and Popcorn and the Incidence of Diverticulitis
2. Methodological Topic: Causation/Risk Factors
 
Questions
  1. What is the clinical queston being addressed?
  2. Were there clearly identified comparison groups that were similar with respect to important determinants of outcome other than the one of interest?
  3. Were the exposures and outcomes measured in the same way in the groups being compared?
  4. Was follow-up sufficiently long and complete?
  5. Is the temporal relationship correct?
  6. Is there a dose-response gradient?
  7. How strong is the association between exposure and outcome and how precise is the estimate of risk?
  8. Are the results applicable to my practice?
  9. What is the magnitude of the risk?
  10. Should I attempt to stop exposure?
  11. State the conclusion. Have the authors addressed the clinical question posed?
  12. Does the evidence support the conclusion?
Articles

1. Nut, Corn and Popcorn Consumption and the Incidence of Diverticulitis; State LL,Liu YL, Syngal S, et al. Nut Corn and Popcorn Consumption and the Incidence of Diverticular Diseae. JAMA 2008;300(8):907-14

2. How to Use an Article About Harm; Mitchell L, Walter S, Lee H, Haines T, Holbrook A, Moyer V, for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature. IV. How to Use an Article about Harm. JAMA 1994; 271(20): 1615-1619
 
Reviews
Clinical Review (Can): Stan Feinberg - University ot Toronto
Clinical Review (US): Rocco Ricciardi - Lahey Clinic
Methodological Review: Carl Brown - University of British Columbia

December 2009

Topics
1. Clinical Topic: The Use of CT for Cervical Spine Clearance in the Unreliable Patient
2. Methodological Topic: Diagnostic Tests
 
Questions
  1. What is the clinical question being addressed?
  2. Is there an independent, blind comparison with a reference standard?
  3. Does the study sample include an appropriate spectrum of patients to which the diagnostic test is to be applied?
  4. Do the results of the test being evaluated influence the decision to perform the reference standard test?
  5. Are the methods for performing the test described in sufficient detail to permit replication?
  6. Are likelihood ratios for the test results, presented or is the data necessary for their calculation included?
  7. Will the reproducibility of the test result and its interpretation be satisfactory in my setting?
  8. Are the results applicabe to my patient?
  9. Will the results change by management?
  10. Will patients be better off as a result of the test?
  11. State the conclusion. Have the authors addressed the clinical question?
  12. Does the evidence support the conclusion?
Articles

1. The Use of CT for Cervical Spine Clearance in the Unreliable Patient; Menaker J, Phip A, Boswell S, Scalea TM. Computed Tomography Alone for Cervical Spine Clearance in the Unstable Patient - Are We There Yet? J Trauma 2008;64:898-904

2. How to Use an Article About a Diagnostic Test; Archibald S, Bhandari M, Thoma A, for the Evidence-Based Surgery Working Group. Usersí Guides to the Surgical Literature: How to Use an Article about a Diagnostic Test. CJS 2001;44(1):17-23
 
Reviews
Clinical Review (Can): John Tallon - Dalhousie University
Clinical Review (Can): John Kortbeek - University of Calgary
Clinical Review (US): LD Britt - University of Virginia
Methodological Review: Andrew Kirkpatrick - University of Calgary

November 2009

Topics
1. Clinical Topic: Biliary Tract Disease and Pregnancy
2. Methodological Topic: Decision Analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Were all of the realistic clinical strategies compared?
  3. Were all clinically relevant outcomes considered?
  4. Was an explicit and sensible process used to identify, select and combine the evidence into probabilities?
  5. Were the utilities obtained in an explicit and sensible way from credible sources?
  6. Was the potential impact of any uncertainty in the evidence determined in the baseline analysis?
  7. Does one stategy result in a clinically important gain for patients?
  8. How strong is the evidence used in the analysis?
  9. Could the uncertainty in the evidence change the results?
  10. Do the probability estimates fit my patients' clinical features?
  11. Do the utilites reflect how my patients would value the outcomes of the decision?
  12. State the conclusion. Have the authors addressed the clinical question posed?
  13. Does the evidence support the conclusion?
Articles

1. Biliary Tract Disease and Pregnancy; Jelin EB, Smink DS, Vernon AH, Brooks DC. Managment of Biliary Tract Disease During Pregnancy: A Decision Analysis. Surg Endosc 2008;22:54-60

2. How to use an clinical decision analysis (a); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group.  Users' Guides to the Medical Literature.  VII. How to Use a Clinical Decision Analysis.  JAMA 1995; 273(16): 1292-1295

3. How to use a clinical decision analysis (b); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group.  Users' Guides to the Medical Literature.  VII. How to Use a Clinical Decision Analysis.  JAMA 1995; 273(20): 1610-1613
 
Reviews
Clinical Review (Can): Micahel Marcaccio - McMaster University
Clinical Review (US): Brendan Visser - Stanford University
Methodological Review: Leigh Neumayer - University of Utah

October 2009

Topics
1. Clinical Topic: WHO Surgical Checklist
2. Methodological Topic: Quality Improvement
 
Questions
  1. What is the clinical question being addressed?
  2. What are the possible biases in a before-after study design and in this study in particular?
  3. Comment on the appropriateness of the checklist items and outcomes of the study.
  4. Were the results of the study clinically and statistically significant?
  5. Is evidence from a RCT necessary before a checklist is adopted?
  6. Is is possible to perform a RCT to assess the value of a checklist?
  7. Would a delay in implementing a checklist until it is further evaluated lead to needless complications and post-operative mortatlity?
  8. ARe the likely treatment benefits worth the potential harm and costs?
  9. Are the findings in this study generalizable to other intstitutions?
  10. State the conclusion. Have the authors addressed the question posed?
  11. Does the evidence support the conclusion?
Articles

1. WHO Surgical Checklist;

Haynes AB, Weiser TG, Berry WR, et al; A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. N Engl J Med 2009;360:491-9


2. Supplementary Appendix - WHO Surgical Checklist;

Haynes AB, Weiser TG, Berry WR, et al; A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. Supp Append. N Engl J Med 2009;360:491-9


3. Improving Care and Knowing How To Do It; Auerbach AD, Landefeld CS, Shojania KG. The Tension Between Needing to Improve Care and Knowing How To Do It. N Engl J Med 2007;357(6):608-13
 
Reviews
Clinical Review (Can): David Urbach - University of Toronto
Clinical Review (US): Richard Thirlby - Virginia Mason University
Methodological Review: Steven Latosinsky - University of Western Ontario

May 2009

Topics
1. Clinical Topic: The Use of Insulin Therapy and Pentaspan in Severe Sepsis
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted form and attributed at its conclusion?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Can the results be applied to my patient care?
  9. Were all clinically important outcomes considered?
  10. Are the likely treatment benefits worth the potential harm and costs?
  11. State the conclusion. Have the authors addressed the question posed?
  12. Does the evidence support the conclusion?
Articles

1. The Use of Insulin Therapy and Pentaspan in Severe Sepsis; Brunkhorst FM, Engel C, Bloos F, et al; Intensive Insulin Therapy and Pentastarch Resuscitation in Severe Sepsis. N Engl J Med 2008;358:125-39

2. Appendix re methodology; Added Reading Appendix re methodology: Brunkhorst FM, Engel C, Bloos F, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008;358:125-39.

3. How to use an article about therapy or prevention (b); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1994 Jan 5; 271(1): 59-63

4. How to use an article about therapy or prevention (a); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1993 Dec 1; 270(21): 2598-2601
 
Reviews
Clinical Review (Can): John Marshall - University of Toronto
Clinical Review (US): Lena Napolitano - University of Michigan
Methodological Review: Prosanto Chaudhury - McGill University

April 2009

Topics
1. Clinical Topic: Lower Incidence of VTE in Laparoscopic vs. Open Surgery
2. Methodological Topic: Causation/Risk Factors
 
Questions
  1. What is the clinical question being addressed?
  2. Were there clearly identified comparison groups that were similar with respect to important determinants of outcome other than the one of interest?
  3. Were the exposures and outcomes measured in the same way in the groups being compared?
  4. Was follow-up sufficiently long and complete?
  5. Is the temporal relationship correct?
  6. Is there a dose-response gradient?
  7. How strong is the association between exposure and outcome?
  8. How precise is the estimate of the risk?
  9. Are the results applicable to my practice?
  10. What is the magnitude of the risk?
  11. Should I attempt to stop the exposure?
  12. State the conclusion. Have the authors addressed the question posed?
  13. Does the evidence support the conclusion?
Articles

1. Lower Incidence of VTE in Laparoscopic vs Open Surgery; Nguyen NT, Hinojosa MW, Fayad C, et al; Laparoscopic Surgery is Associated with a Lower Incidence of Venous Thromboembolism Compared with Open Surgery. Ann Surg 2007;246(6):1021-27

2. How to use an article about harm; Mitchell L, Walter S, Lee H, Haines T, Holbrook A, Moyer V, for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature. IV. How to Use an Article about Harm. JAMA 1994; 271(20): 1615-1619
 
Reviews
Clinical Review (Can): Dan Birch - University of Alberta
Clinical Review (US): Joseph Caprini - Northwestern University
Clinical Review (US): Lee Swanstrom - Oregon Health Science University
Methodological Review: Tara Mastracci - Cleveland Clinic

March 2009

Topics
1. Clinical Topic: Student Quality of Life Declines During Third Year Surgical Clerkship
2. Methodological Topic: Quality of Life
 
Questions
  1. What is the clinical question being addressed?
  2. Have the investigators measured aspects of students' lives that students consider important?
  3. Did the HRQL Instruments work in the way they are supposed to?
  4. Are there important aspects of HRQL that have been omitted?
  5. What was the magnitude of the effect on HRQL?
  6. Will the information from the study help inform other students and medical educators?
  7. Was the setting similar to that of most medical schools and clerkships?
  8. State the conclusion. Have the authors addressed the question posed?
  9. Does the evidence support the conclusion?
Articles

1. Student Quality of Life Declines During Third Year Clerkship; Goldin SB, Wahi MM, Farooz OS et al; Student Quality-of-Life Declines During Third Year Surgical Clerkship. J of Surg Research 2007;143(1):151-57

2. How to use articles about health related quality of life; Guyatt GH, Naylor CD, Juniper E, Heyland DK, Jaeschke R, Cook DJ, for the Evidence-Based Medicine Working Group: User's Guide to the Medical Literature. XII. How to Use Articles About Health-Related Quality of Life. JAMA 1997; 277 (15): 1232-1237
 
Reviews
Clinical Review (Can): Sarkis Meterissian - McGill University
Clinical Review (US): Rebecca Evangelista - Georgetown University/Stephen Evans - Georgetown University
Methodological Review: Robin McLeod - University of Toronto

February 2009

Topics
1. Clinical Topic: Use of Colonic Stents in Emergent Malignant Left Colonic Obstruction
2. Methodological Topic: Decision Analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Were all of the realistic clinical strategies compared?
  3. Were all clinically relevant outcomes considered?
  4. Was an explicit an sensible process used to identify, select and combine the evidence into probabilities?
  5. Were the utilities obtained in an explicit and sensible way from credible sources?
  6. Was the potential impact of any uncertainty in the evidence determined in the baseline analysis?
  7. Does one strategy result in a clinically important gain for patients?
  8. How strong is the evidence used in the analysis?
  9. Could the uncertainty in the evidence change the results?
  10. Do the probability estimates fit my patients'clinical features?
  11. Do the utilities reflect how my patients would value the outcomes of the decision?
  12. State the conclusion. Have the authors addressed the question?
  13. Does the evidence support the conclusion?
Articles

1. Use of Colonic Stents in Emergent Malignant Left Colonic Obstruction; Govindarajan A, Naimark D, Coburn NG, et al; Use of Colonic Stents in Emergent Malignant Left Colonic Obstruction: A Markov Chain Monte Carlo Decision Analysis. Dis Colon Rectum 2007;50(11):181-24

2. How to use a Clinical Decision Analysis - A; Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group.  Users' Guides to the Medical Literature.  VII. How to Use a Clinical Decision Analysis. JAMA 1995;273(16):1292-1295

3. How to use a clinical decision analysis (b); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group.  Users' Guides to the Medical Literature.  VII. How to Use a Clinical Decision Analysis.  JAMA 1995; 273(20): 1610-1613
 
Reviews
Clinical Review (Can): John Heine - University of Calgary
Clinical Review (US): Heidi Nelson - Mayo Clinic Rochester
Methodological Review: Harry Henteleff - Dalhousie University/Suzanne Cutter - Cedars Sinai Medical Center, Los Angeles

January 2009

Topics
1. Clinical Topic: Nonsurgical Treatment of Appendiceal Abscess or Phlegmon
2. Methodological Topic: Meta-analysis - non experimental design
 
Questions
  1. What is the clinical question being addressed?
  2. Did the review explicity address a sensible clinical question?
  3. Was the search for relevant studies detailed and exhaustive?
  4. Was there a qualitative and/or quantitative assessment of heterogeneity?
  5. Are the interventions adequately described?
  6. Were the clinically important outcomes considered?
  7. Was there adequate reporting of results including descriptive information of each study?
  8. What are the overall results of the review?
  9. Was there an assessment of potential biases?
  10. Was there a discussion of what future research is required?
  11. State the conclusion. Have the authors addressed the question?
  12. Does the evidence support the conclusion?
Articles

1. Nonsurgical Treatment of Appendiceal Abscess or Phlegmon; Andersson RE, Petzold MG; Nonsurgical Treatment of Appendiceal Abscess or Plegmon. A Systematic Review and Meta-analysis. Ann Surg 2007;246(5):741-48

2. Meta-analysis of Observational Studies in Epidemiology; Stroup DF, Berlin JA, Morton SC, et al for the Meta-analysis of Observational Studies in Epidemiology (MOOSE) Group; Meta-analysis of Observational Studies in Epidemiology. JAMA 2000;283(15):2008-12
 
Reviews
Clinical Review (Can): Susan Reid - McMaster University
Clinical Review (US): Neil Hyman - University of Vermont
Methodological Review: Steve Latosinsky - University of Manitoba

December 2008

Topics
1. Clinical Topic: Prophylactic Antibiotics for Mesh Inguinal Hernioplasty
2. Methodological Topic: Meta-analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Did the review explicitly address a sensible clinical question?
  3. Was the search for relevant studies detailed and exhaustive?
  4. Were the primary studies of high methodologic quality?
  5. Were assessments of studies reproducible?
  6. Were the results similar from study to study?
  7. What are the overall results of the review?
  8. How precise were the results?
  9. Were the clinically important outcomes considered?
  10. Are the benefits worth the costs and potential risks?
  11. State the conclusion. Have the authors addressed the question?
  12. Does the evidence support the conclusion?
Articles

1. Prophylactic Antibiotics for Mesh Inguinal Hernioplasty; Sanabria A, Dominguez LC, Valdiviseso E, Gomez G; Prophylactic Antibiotics for Mesh Inguinal Hernioplasty. A Meta-analysis. Ann Surgery 2007;245(3):392-96

2. Systematic Review and Meta-analysis; Bhandari M, Devereaux PJ, Montore V, et al; for the Evidence Based Surgery Working
Group. Usersí Guide to Surgical Literature: How to Use a Systematic Review and Meta-
analysis. CJS 2004;47(1):60-67
 
Reviews
Clinical Review (Can): Brock Vair - Dalhousie University
Clinical Review (US): Jon S.Thompson - University of Nebraska
Methodological Review: Leigh Neumayer - University of Utah

November 2008

Topics
1. Clinical Topic: CT Angiography for Diagnosis of Blunt Cervical Vascular Injury
2. Methodological Topic: Diagnostic Tests
 
Questions
  1. What is the clinical question being addressed?
  2. Is there an independent, blind comparison with a reference standard?
  3. Does the study sample include an appropriate spectrum of patients to which the diagnostic test is to applied?
  4. Do the results of the test being evaluated influence the decision to perform the reference standard test?
  5. Are the methods for performing the test described in sufficient detail to permit replication?
  6. Are likelihood ratios for the test results, presented or is the data necessary for their calculation included?
  7. Will the reproducibility of the result and its interpretation be satisfactory in my setting?
  8. Are the results applicable to my patient?
  9. Will the results change my management?
  10. State the conclusion. Have the authors addressed the question?
  11. Does the evidence support the conclusion?
Articles

1. CT Angiography for Diagnosis of Blunt Cervical Vascular Injury; Eastman AL, Chason DP, Perez CL, et al; Computed Tomographic Angiography for the Diagnosis of Blunt Cervical Vascular Injury: Is It Ready for Primetime? J Trauma 2006;60(5):925-29

2. How to use an article about a diagnostic test; Archibald S, Bhandari M, Thoma A, for the Evidence-Based Surgery Working Group. Usersí Guides to the Surgical Literature: How to Use an Article about a Diagnostic Test. CJS 2001;44(1):17-23
 
Reviews
Clinical Review (Can): David Evans - University of British Columbia
Clinical Review (US): Wayne Meredith - Wake Forest University
Methodological Review: Andrew Kirkpatrick - Univeristy of Calgary

October 2008

Topics
1. Clinical Topic: On-Demand vs. Planned Relaparotomy for severe peritonitis
2. Methodological Topic: Number Needed to Treat/Confidence Intervals/Equivalence
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusions?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect? Calculate 95% CI around the difference in 30 day mortality rates between groups.
  8. State the estimates upon which the sample size was calculated. In retrospect, were they accurate?
  9. Can the reslults be applied to my patient care?
  10. Were all clinically important outcomes considered?
  11. Are the likely treatment benefits worth the potential harm and costs?
  12. State the conclusion. Have the authors addressed the question posed?
  13. Does the evidence support the conclusion?
Articles

1. On-Demand vs. Planned Relaparotomy for Severe Peritonitis;

van Ruler O, Mahler CW, Boer KR, et al; Comparison of On-Deman vs. Planned Relaparotomy Strategy in Patients with Severe Peritonitis. A Randomized Trial. JAMA 2007;298(8):865-73


2. How to Use an Article Evaluating Surgical Interventions; Urschel JD, Goldsmith CH, Tandan VR, Miller JD; for the Evidence-Based Surgery Working Group.  Users' Guide to Evidence-Based Surgery: How to Use an Article Evaluating Surgical Interventions  CJS 2001; 44(2): 95-100
 
Reviews
Clinical Review (Can): Morad Hameed - University of British Columbia
Clinical Review (US): Michael Sarr - Mayo Clinic Rochester
Methodological Review: Karen Brasel - Medical College of Wisconsin

May 2008

Topics
1. Clinical Topic: Urban vs. rurual inpatient case mix difference
2. Methodological Topic: Administrative Data
 
Questions
  1. What is the clinical question being addressed?
  2. What is the source of the data?
  3. Are the data accurate and valid?
  4. What medical services were assessed? How are they ascertained?
  5.  Are the differences in the rates of use of medical services clinically significant?
  6. Are there any factors that might explain the diffferences in use of medical services?
  7. State the conclusion. Have the authors addressed the question?
  8. Does the evidence support the conclusion?
  9. Can these data be used to implement changes in health care provision and if so, how?
Articles

1. Urban vs rurual inpatient case mix differences;

VanBibber M, Zuckerman RS, Finlayson SRG; Rural Versus Urban Inpatient Case-Mix Differences in the US. J Am Coll Surg. 2006; 203(6): 812-16


2. Small-Area variations: what are they and what do they mean?; Health Services Research Group. Small-Area Variations: What are They and What do They Mean?  CMAJ. 1992;146(4):467-70
 
Reviews
Clinical Review (Can): Bill Pollett - Memorial University
Clinical Review (US): Tom Cogbill - Gunderson Lutheran Medical Center
Methodological Review: Andrew Kirkpatrick - University of Calgary

April 2008

Topics
1. Clinical Topic: SLNB vs. standard axillary treatment in operable breast ca
2. Methodological Topic: Quality of Life
 
Questions
  1. What is the clinical question being addressed?
  2. Have the investigators measured aspects of patients' lives that patients consider important?
  3. Did the HRQL instruments work in the way they are supposed to?
  4.  Are the important aspects of HRQL that have been omitted?
  5. If there were trade-offs between quality and quantity of life, or an economic evaluation, have the investigators used the right measure?
  6. What was the magniturd of the effect on HRQL?
  7. Will the information from the study help me inform my patients?
  8. Did the study design simulate the clinical practice?
  9. State the conclusion. Have the authors addressed the clinical question?
  10. Does the evidence support the conclusion?
Articles

1. SNLB vs standard axillary treatment in operable breast ca; Mansel RE, Fallowfield L, Kissin M, et al; Randomized Multicenter Trial of Sentinel Node Biopsy Versus Standard Axillary Treatment in Operable Breast Cancer: The ALMANC Trial. J Natl Cancer Inst 2006; 98(9): 599-609

2. How to use an article about health related quality of life; Guyatt GH, Naylor CD, Juniper E, Heyland DK, Jaeschke R, Cook DJ, for the Evidence-Based Medicine Working Group: User's Guide to the Medical Literature. XII. How to Use Articles About Health-Related Quality of Life. JAMA 1997; 277 (15): 1232-1237
 
Reviews
Clinical Review (Can): Kelly Dabbs - University of Alberta
Clinical Review (US): Fred Moffat - University of Miami
Methodological Review: Steve Latosinsky - University of Manitoba

March 2008

Topics
1. Clinical Topic: Simple scoring system for predicting acute pancreatitis
2. Methodological Topic: Prognosis/Natural History
 
Questions
  1. What is the clinical question being addressed?
  2. Was there a representative and well-defined sample of patients at a similar point in the course of the disease?
  3. Was follow-up sufficiently long and complete?
  4. Were objective unbiased outcome criteria used?
  5. Was there adjustment for important prognositc factors?
  6. How large is the likelihood of the outcome evient(s) in a specified period of time?
  7. How precise are the estimates of likelihood?
  8. Weill the results help me in caring for my patients?
  9. Will the results lead directly to selecting or avoiding therapy?
  10. Are the results useful for reassuring or counselling patients?
  11. State the conclusion. Have the authors addressed the clinical question?
  12. Does the evidence suppport the conclusion?
Articles

1. Simple scoring system for the prediction of acute pancreatitis; Ueda T, Takeyama Y, Yasuda T, et al; Simple scoring system for the prediction of the prognosis of severe acute pancreatitis. Surgery 2007; 141 (1): 51-8

2. Prognositc factors in acute pancreatitis; Ranson JHC, Rifkind KM, Roses DF et al; Prognostic Signs and the Role of Operative Management in Acute Pancreatitis. Surgery, Gynecology & Obstetrics 1974;139:69-81

3. How to use an article about prognosis; Laupacis A, Wells G, Richardson WS, Tugwell P, for The Evidence-Based Working Group: Users' Guides to the Medical Literature. V. How to Use an Article About Prognosis. JAMA 1994; 272: 234-237
 
Reviews
Clinical Review (Can): Elijah Dixon - University of Calgary
Clinical Review (US): Karen Horvath - University of Washington
Methodological Review: Leigh Neumayer - University of Utah

February 2008

Topics
1. Clinical Topic: Evaluation of rectal bleeding in adults
2. Methodological Topic: Decision Analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Were all of the realistic clinical strategies compared?
  3. Were all clinically relevant outcomes considered?
  4. Was an explicit and sensible process used to identify, select and combine the evidence into probabilities? 
  5. Were the utilities obtained in an explicit and sensible way from credible sources?   
  6. Was potential impact of any uncertainty in the evidence determined in the baseline analysis?
  7. Does one strategy result in a clinically important gain for patients?
  8. How strong is the evidence used in the analysis?
  9. Could the uncertainty in the evidence change the results?
  10. Do the probabilty estimates fit my patients' clinical features?
  11. Do the utilities reflect how my patietns would value the outcomes of the decision?
  12. State the conclusion. Have the authors addressed the clinical question?
  13. Does the evidence support the conclusion? 
Articles

1. Evaluation of rectal bleeding in adults; Allen E, Nicolaidis C, Helfand M; The Evaluation of Rectal Bleeding in Adults. A cost-effectiveness Analysis Comparing Four Diagnostic Strategies. JGen Intern Med 2005; 20: 81-90 

2. How to use a clinical decision analysis (a); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group. Usersí Guides to the Medical Literature. VII. How to Use a Clinical Decision Analysis. JAMA 1995; 273(16): 1292-95

3. How to use a clinical decision analysis (b); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group.  Users' Guides to the Medical Literature.  VII. How to Use a Clinical Decision Analysis.  JAMA 1995; 273(20): 1610-1613
 
Reviews
Clinical Review (Can): Paul Johnson - Dalhousie University
Clinical Review (US): George Chang - University of Texas M.D. Anderson Cancer Center
Methodological Review: Mark Taylor - Lakeridge Health Centre

January 2008

Topics
1. Clinical Topic: Fast track surgery
2. Methodological Topic: Meta-analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Did the review explicitly address a sensible clinical question?
  3. Was the search for relelvant studies detailed and exhaustive?
  4. Were the primary studies of high methodologic quality?  
  5. Were assessments of studies reproducible?
  6. Were the results similar from study to study?
  7. What are the overall results of the review? 
  8. How precise were the results?
  9. Were the clinically important outcomes considered?
  10. Are the benefits worth the costs and potential risks?
  11. State the conclusion. Have the authors addressed the clinical question?
  12. Does the evidence suppport the conclusion?
Articles

1. Fast track surgery; Wind J, Polle SW, Fung Kon Jin PHP, et al; Systematic review of enhanced recovery programmes in colonic surgery. Br. J. Surg 2006; 93: 800-09

2. How to use an article on a systematic review and meta-analysis; Bhandari M, Devereaux PJ, Montore V, et al; for the Evidence Based Surgery Working Group. Usersí Guide to Surgical Literature: How to Use a Systematic Review and Meta-analysis. CJS 2004; 47(1): 60-67 
 
Reviews
Clinical Review (Can): Zane Cohen - University of Toronto
Clinical Review (US): Anthony Senagore - Michigan State University
Methodological Review: Tara Mastracci - McMaster University

December 2007

Topics
1. Clinical Topic: Perioperative chemotherapy vs. surgery alone for gastric ca
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized and concealed?
  3.  Were all patients who entered the trial properly accounted for?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Were the study patients similar to my patients?
  9. Were the measured outcomes clinically relevant?
  10. Were all clinically important outcomes considere?
  11. Are my surgical skills similar to those of the study surgeons?
  12. State the conclusion. Have the authors addressed the clinical question?
  13. Does the evidence support the conclusion?
Articles

1. Perioperative chemotherapy vs. surgery alone for gastic ca; Cunningham D, Allum WH, Stenning SP, et al; Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer. NEJM 2006; 355 (1): 11-20

2. How to use an article about therapy or prevention (a); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1993 Dec 1; 270(21): 2598-2601

3. How to use an article about therapy or prevention (b); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1994 Jan 5; 271(1): 59-63
 
Reviews
Clinical Review (Can): Rick Malthaner - University of Western Ontario
Clinical Review (US): Carlton Barnett - Unviersity of Texas
Methodological Review: Harry Henteleff - Dalhousie University

November 2007

Topics
1. Clinical Topic: Watch full waiting vs. hernia repair in minimally symptomatic men
2. Methodological Topic: Number Needed to Treat/Confidence Intervals/Equivalence
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusion?
  4. Were patients, their clinicans and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental interventions, were the groups treated equally?
  7. How large and precise was the treatment effect? Calculate 95% CI around the difference in 30 day mortatliy rates between groups.
  8. State the estimates upon which the sample size was calculated. In retrospect, were they accurate?
  9. Can the results be applied to my patient care?
  10. Were all clinically important outcomes considered?
  11. Are the likely treatment benefits worth the potential harm and costs?
  12. State the conclusion. Have the authors addressed the clinical question?
  13. Doses the evidence support the conclusion?
Articles

1. Watchful waiting vs. hernia repair in minimally symptomatic men; Fitzgibbons R, Hurder-Giobbie A, Gibbs JO, et al; Watchful Waiting vs. Repair of Inguinal Hernia in Minimally Symptomatic Men. A Randomized Clinical Trial. JAMA 2006; 295: 285-292

2. Measures of precision (confidence intervals); Montori V, Klienbart J, Newman T, et al, for the Evidence Based Medicine Teaching Tips Working Group. Tips for learners of Evidence-based medicine: 2. Measures of precision (confidence intervals) CMAJ 2004;171(6):611-15
 
Reviews
Clinical Review (Can): Bill Fitzgerald - Charles S. Curtis Memorial Hospital
Clinical Review (US): Demetrius Litwin - University of Massachusetts
Methodological Review: Jeffrey Barkun - McGill University

October 2007

Topics
1. Clinical Topic: Factor VIIa as adjuvent therapy for bleeding in trauma patients
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized and concealed?
  3.  Were all patients who entered the trial properly accounted for?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Were the study patients similar to my patients?
  9. Were the measured outcomes clinically relevant?
  10. Were all clinically important outcomes considere?
  11. Are my surgical skills similar to those of the study surgeons?
  12. State the conclusion. Have the authors addressed the clinical question?
  13. Does the evidence support the conclusion?
Articles

1. Factor VII as adjuvent therapy for bleeding in trauma patients; Boffard DK, Riou B, Warren B et al, for the NovoSeven Trauma Study Group.  Recombinant Factor VIIa Adjunctive Therapy for Bleeding Control in Severely Injured Trauma Patients: Two Parallel Randomized, Placebo-Controlled, Double-Blind Clinical Trials. Journal of Trauma 2005; 59(1): 8-18

2. How to use an article about therapy or prevention (a); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1993 Dec 1; 270(21): 2598-2601

3. How to use an article about therapy or prevention (b); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1994 Jan 5; 271(1): 59-63
 
Reviews
Clinical Review (Can): John Drover - Queens University
Clinical Review (US): Brent Eastman - University of California, San Diego
Methodological Review: Karen Brasel - Medical College of Wisconsin

May 2007

Topics
1. Clinical Topic: SLNB in early stage breast cancer
2. Methodological Topic: Guidelines
 
Questions
  1. What is the clinical question being asked?
  2. Were all important otpions and outcomes considered?
  3. Was an explicit and sensible process used to identify, select and combine evidence?
  4. Was an explicit and sensible process used to consider the relative value of different outcomes?
  5. Is the guideline likely to account for important recent developments?
  6. Has the guideline been subjected to peer review and testing?
  7. Are practical clinically important recommendations made?
  8. How strong are the recommendations?
  9. What is the impact of uncertainty associated with the evidence and values used in the guidelines?
  10. Is the primary objective of the guidelines consistent with your objectives?
  11. Are the recommendations applicable to your patients?
  12. State the conclusion. Have the authors addressed the question posed?
  13. Does the evidence support the conclusion?
Articles

1. ASCO guideline recommendations for sentinel lymph node biopsy in early stage breast cancer; Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology Guideline Recommendations for Sentinel Lymph Node Biopsy in Early Stage Breast Cancer. JCO 2005;23(30):7703-20

2. How to use clinical practice guidelines (a); Hayward RSA, Wilson MC, Tunis SR, Bass EB, Guyatt G, for the Evidence-Based Medicine Working Group. Users' Guide to the Medical Literature. VIII How to use Clinical Practice Guidelines. JAMA 1995;274(7):570-74

3. How to use clinical practice guidelines (b); Wilson MC, Hayward RSA, Tunis SR, Bass EB, Guyatt G, for the Evidence-Based Medicine Working Group.  Users' Guide to the Medical Literature. VIII How to Use Clinical Practice Guidelines.  JAMA 1995;274(20):1630-32
 
Reviews
Clinical Review (Can): Sarkis Meterissian - McGill University
Clinical Review (US): Kelly McMasters - University of Louisville
Methodological Review: Leigh Neumayer - University of Utah

April 2007

Topics
1. Clinical Topic: CT colonography vs. colonoscopy for colon cancer screening
2. Methodological Topic: Economic Analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Did the anlaysis provide a full economic comparison of health care strategies?
  3. Was a broad enough viewpoint adopted?
  4. Were all the relevant clinical strategies compared?
  5. Were the costs and outcomes properly measured and valued?
  6. Was clinical effectiveness established?
  7. Were costs measured accurately?
  8. Were data on costs and outcomes appropriately integrated?
  9. Was appropriate allowance made for uncertainties in the analysis?
  10. What were the incremental costs and outcomes of each stategy?
  11. Do incremental costs and outcomes differ between subgroups?
  12. Could my patients expect similar health outcomes?
  13. State the conclusion. Have the authors addressed the question posed?
  14. Does the evidence support the conclusion?
Articles

1. Cost effectiveness of CT colonography vs. colonoscopy for colorectal cancer screening; Heitman SJ, Manns BJ, Hilsden RJ, et al. Cost-Effectiveness of Computerized Tomographic Colonography versus Colonoscopy for Colorectal Cancer Screening. CMAJ 2005;173(8):877-81

2. How to use an article on economic analysis; Thoma A, Sprague S, Tandan V; for the Evidence-Based Surgery Working Group Usersí Guide to the Surgical Literature: How to Use an Article on Economic Analysis. CJS 2001;44(5):347-54
 
Reviews
Clinical Review (Can): Nancy Baxter - University of Toronto
Clinical Review (Can): Linda Rabeneck - University of Toronto
Clinical Review (Can): Tanya Chawla - University of Toronto
Clinical Review (US): James Church - Cleveland Clinic
Methodological Review: Harry Heteleff - Dalhousie University

March 2007

Topics
1. Clinical Topic: MRI & Mammogram for breast cancer screening
2. Methodological Topic: Diagnostic Tests
 
Questions
  1. What is the clinical question being addressed?
  2. What diagnostic tests are being compared?
  3. Did the study sample include an appropriate spectrum of patients?
  4. Did the results of one test influence the decision to perform the others?
  5. Are the methods for performing the test described in sufficient detail to permit replication?
  6. Comment on the test characteristics and calculate the likelihood ratios for each test.
  7. Will the reproducibility of the test results and their interpretation be satisfactory in my setting?
  8. Should MRI be used to screen high risk patients or is further evaluation required?
  9. Are the benefits and harms discussed adequately?
  10. Does cost-effectiveness need to be addressed?
  11. Do patient's values and preferences need to be considered?
  12. State the conclusion. Have the authors addressed the question posed?
  13. Does the evidence support the conclusion?
Articles

1. Efficacy of MRI and mammogram for breast cancer screening in woman with familial or genetic predisposition;  Kriege M, Brekelmans CTM, Boetes C, et al. Efficacy of MRI and Mammography for Breast-Cancer Screening in Women with Familial or Genetic Predisposition. NEJM 2004;351(5):427-37  

2. How to use an article about a diagnostic test; Archibald S, Bhandari M, Thoma A, for the Evidence-Based Surgery Working Group. Usersí Guides to the Surgical Literature: How to Use an Article about a Diagnostic Test. CJS 2001;44(1):17-23
 
Reviews
Clinical Review (Can): Geoffrey Porter - Dalhousie University
Clinical Review (US): Todd Tuttle - University of Minnesota
Methodological Review: Steven Latosinsky - University of Manitoba

February 2007

Topics
1. Clinical Topic: PET/CT in the mangement of pancreatic ca
2. Methodological Topic: Diagnostic Tests
 
Questions
  1. What is the clinical question being addressed?
  2. Is there an independent, blind comparison with a reference standard?
  3. Does the study sample include an appropriate spectrum of patients to which the diagnostic test is to be applied?
  4. Do the results of the test being evaluated influence the decision to perform the reference standard result?
  5. Are the methods for performing the test described in sufficient detail to permit replication?
  6. Are likelihood ratios for the test result presented or is the data necessary for their calculation included?
  7. Will the reproducibility of the test result and its interpretation be satisfactory in my setting?
  8. Are the results applicable to my patient?
  9. Will the results change my management?
  10. Will the patients be better off as a result of the test?
  11. State the conclusion. Have the authors addressed the question posed?
  12. Does the evidence support the conclusion?
Articles

1. PET/CT influences on the management of resectable pancreatic cancer; Heinrich S, Goerres GW, Schšfer M, et al. Positron Emission Tomography/Computed Tomography Influences on the Management of Resectable Pancreatic Cancer and its Cost Effectiveness.  Ann of Surg. 2005;242(2):235-43

2. How to use an article about a diagnostic test; Archibald S, Bhandari M, Thoma A, for the Evidence-Based Surgery Working Group. Usersí Guides to the Surgical Literature: How to Use an Article about a Diagnostic Test. CJS 2001;44(1):17-23
 
Reviews
Clinical Review (Can): Garth Warnock - University of British Columbia
Clinical Review (US): Keith Lillemoe - Indiana University
Methodological Review: Mark Taylor - University of Manitoba

January 2007

Topics
1. Clinical Topic: Treatment of asymptomatic gall stones
2. Methodological Topic: Decision Analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Were all of the relaistic clinical strategies compared?
  3. Were all clinically relevant outcomes considered?
  4. Was an explicit and sensible process used to identify, select and combine the evidence into probabilities?
  5. Were the utilities obtained in an explicit and sensible way from credible sources?
  6. Was the potential impact of any uncertainty in the evidence determined in the baseline analysis?
  7. Does one strategy result in a clinically important gain for patients?
  8. How strong is the evidence used in the analysis?
  9. Could the uncertainty in the evidence change the results?
  10. Do the probability estimates fit my patients' clinical features?
  11. Do the utilities reflect how my patients would value the outcomes of the decision?
  12. State the conclusion. Have the authors addressed the question posed?
  13. Does the evidence support the conclusion?
Articles

1. Small gall stones are associated with an increased risk of pancreatitis, is there a potential benefit of prophylactic cholecystectomy; Venneman NG, Buskens E, Besselink MGH, et al. Small Gall Stones are Associated with Increased Risk of Acute Pancreatitis: Potential Benefits of Prophylactic Cholecystectomy. Am J Gastro 2005;100(11):2540-50 

2. How to use a clinical decision analysis (a); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group. Usersí Guides to the Medical Literature. VII. How to Use a Clinical Decision Analysis. JAMA 1995; 273(16): 1292-95

3. How to use a clinical decision analysis (b); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group. Usersí Guides to the Medical Literature. VII. How to Use a Clinical Decision Analysis. JAMA 1995;273(20):1610-13
 
Reviews
Clinical Review (Can): Michael Marcaccio - McMaster University
Clinical Review (US): Nat Soper - Northwestern University
Methodological Review: Jeffrey Barkun - McGill Unviersity

December 2006

Topics
1. Clinical Topic: EVAR 1 trial
2. Methodological Topic: Number Needed to Treat/Confidence Intervals/Equivalence
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusion?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect? Calculate 95% CI around the difference in 30day mortality rates between groups.
  8. State the estimates upon which the sample size was calculated. In  retrospect, were they accurate?
  9. Can the results be applied to my patient care?
  10. Were all clinically important outcomes considered?
  11. Are the likely treatment benefits worth the potential harm and costs?
  12. State the conclusion. Have the authors addressed the question posed?
  13. Does the evidence support the conclusion?
Articles

1. Endovasculare aneurysm repair vs. open repair in patients with abdominal aortic aneurysm; EVAR Trial participants. Endovascular Aneurysm Repairs vs Open Repair in Patients with Abdominal AorticAneurysm (EVAR Trial 1): Randomised Controlled Trial. Lancet 2005;365:2179-86

2. Measures of precision (confidence intervals); Montori V, Klienbart J, Newman T, et al, for the Evidence Based Medicine Teaching Tips Working Group. Tips for learners of Evidence-based medicine: 2. Measures of precision (confidence intervals) CMAJ 2004;171(6):611-15
 
Reviews
Clinical Review (Can): Paul Petrasek - University of Calgary
Clinical Review (US): Julie Freischlag - John Hopkins School of Medicine
Methodological Review: Tara Mastracci - McMaster University

November 2006

Topics
1. Clinical Topic: Stapled hemorrhoidopexy vs conventional hemorrhoidectomy
2. Methodological Topic: Meta-analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Did the review explicitly address a sensible clinical question?
  3. Was the search for relevant studies detailed and exhaustive?
  4. Were the primary studies of high methodologic quality?
  5. Were assessments of studies reproducable?
  6. Were the results similar from study to study?
  7. What are the oveall results of the review?
  8. How precise were the results?
  9. Were the clinically important outcomes considered?
  10. Are the benefits worth the costs and potential risks?
  11. State the conclusion. Have the authors addressed the question posed?
  12. Does the evidence support the conclusion?
Articles

1. Stapled hemorrhoidopexy vs conventional hemorrhoidectomy; Nisar PJ, Acheson AG, Neal KR, et al. Stapled Hemorrhoidopexy Compared with Conventional Hemorrhoidectomy: Systematic Reviews of Randomized Controlled Trials.  DCR 2004;47(11):1837-45

2. How to use an article on a systematic review and meta-analysis; Bhandari M, Devereaux PJ, Montore V, et al; for the Evidence Based Surgery Working Group. Usersí Guide to Surgical Literature: How to Use a Systematic Review and Meta-analysis. CJS 2004; 47(1): 60-67 
 
Reviews
Clinical Review (Can): Marcus Burnstein - University of Toronto
Clinical Review (US): Rob Madoff - University of Minnesota
Methodological Review: Andy Kirkpatrick - University of Calgary

October 2006

Topics
1. Clinical Topic: Surgical site infections
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized and concealed?
  3. Were all patients who entered the trial properly accounted for?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Were the study patients similar to my patients?
  9. Were the measured outcomes clinically relevant?
  10. Were all clinically important outcomes considered?
  11. Are my surgical skills similar to those of the study surgeons?
  12. State the conclusion. Have the authors addressed the question posed?
  13. Does the evidence support the conclusion?
Articles

1. Risk of surgical wound infections reduced with supplemental perioperative oxygen; Belda FJ, Aguilera L, GarcŪa de la Asunciůn J, et al; Supplemental Perioperative Oxygen and the Risk of Surgical Wound Infection. A Randomized Controlled Trial. JAMA 2005;294(16):2035-42

2. How to use an article about evaluating surgical interventions; Urschel JD, Goldsmith CH, Tandan VR, Miller JD; for the Evidence-Based Surgery Working Group. Usersí Guide to Evidence-Based Surgery: How to Use an Article Evaluating Surgical Interventions CJS 2001; 44(2): 95-100
 
Reviews
Clinical Review (Can): Donna McRitchie - University of Toronto
Clinical Review (US): Patch Dellinger - University of Washington
Methodological Review: Karen Brasel - Medical College of Wisconsin

May 2006

Topics
1. Clinical Topic: Treatment of occult pneumothoraces from blunt trauma
2. Methodological Topic: Number Needed to Treat/Confidence Intervals/Equivalence
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusion?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect? Calculate 95% CI around the difference in 30-day mortality rates between groups.
  8. State the estimates upon which the sample size was calculated. In retrospect, were they accurate?
  9. Can the results be applied to my patient care?
  10. Were all clinically important outcomes considered?
  11. Are the likely treatment benefits worth the potential harm and costs?
  12. State the conclusion. Have the authors addressed the question posed?
  13. Does the evidence support the conclusion.
Articles

1. Treatment of occult pneumothoraces from blunt trauma; Brasel K, Stafford RE, Weigelt JA, et al; Treatment of Occult Pneumothoraces from Blunt Trauma. J Trauma 1999; 46(6): 987-91

2. Measures of precision (confidence intervals);  Montori V, Klienbart J, Newman T, et al, for the Evidence Based Medicine Teaching Tips Working Group. Tips for learners of Evidence-based medicine: 2. Measures of precision (confidence intervals) CMAJ 2004; 171(6): 611-15
 
Reviews
Clinical Review (Can): Mary van Wijngaarden-Stephens - University of Alberta
Clinical Review (US): Timothy Fabian - University of Tennessee
Methodological Review: Andy Kirkpatrick - University of Calgary

April 2006

Topics
1. Clinical Topic: Prerandomization of surgical training for the NSABP B-32 trial
2. Methodological Topic: Knowledge Transfer
 
Questions
  1. Outline the training process used in the NSABP B-32 trial to teach sentinel node biopsy
  2. What outcomes were used to assess surgeon proficiency?
  3. Were the outcome measures clinically relevant? 
  4. Do the results support the conclusion that "a large number of surgeons capable of performing sentinel lymph node biopsy in a standardized fashion with a high degree of protocol compliance and pathologic accuracy."? 
  5. Is this training process applicable to transfer of new skills to practicing surgeons?
  6. Is learning new technical skills important to you in practice?
  7. What is the optimal method for you personally to learn new skills?
Articles

1. Prerandomization of surgical training for the NSABP B-32 trial; Harlow SP, Krag DN Julian TB, et al; Prerandomization Surgical Training for the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32 Trial. A Ranomized Phase III Clinical Trial to compare Sentinel Node Resection to Conventional Axillary Dissection in Clinically Node-Negative Breast Cancer. Ann Surg 2005; 241(1): 48-54

2. Improving continuing medical education for surgical techniques; Rogers DA, Elstein AS, Bordage G; Improving Continuing Medical Education for Surgical Techniques: Applying the Lessons Learned in the First Decade of Minimal Access Surgery Ann of Surg 2001; 233(2): 159-66
 
Reviews
Clinical Review (Can): Helen MacRae - University of Toronto
Clinical Review (US): Marilyn Leitch - University of Texas
Methodological Review: Leigh Neumayer - University of Utah

March 2006

Topics
1. Clinical Topic: Validation of the American joint committee on cancer melanoma staging system
2. Methodological Topic: Prognosis/Natural History
 
Questions
  1. What is the clinical question being addressed?
  2. Was there a representative and well-defined sample of patients at a similar point in the course of the disease?
  3. Was follow-up sufficiently long and complete?
  4. Were objective and unbiased outcome criteria used?
  5. Was there adjustment for important progostic factors?
  6. How large is the likelihood of the outcome event(s) in a specified period of time?
  7. How precise are the estimates of likelihood?
  8. Will the results help me in caring for my patients?
  9. Will the results lead directly to selecting or avoiding therapy?
  10. Are the results useful for reassuring or counselling patients?
  11. State the conclusion. Have the authors addressed the question?
  12. Does the the evidence support the conclusion?
Articles

1. Progostic factors analysis of 17,600 melanoma patients; Balch CM, Soong SJ, Gerdhenwoald J et al; Prognostic Factors Analysis of 17,600 Melanoma Patients: Validation of the American Joint Committee on Cancer Melanoma Staging System. J Clin Oncol 2001; 19(16): 3622-34

2. How to use an article about prognosis; Laupacis A, Wells G, Richardson WS, Tugwell P, for The Evidence-Based Working Group: Users' Guides to the Medical Literature. V. How to Use an Article About Prognosis. JAMA 1994; 272: 234-237
 
Reviews
Clinical Review (Can): Ralph George - Queen's University
Clinical Review (US): Philip Haigh - Kaiser Permanente Los Angeles Medical Center
Methodological Review: Steven Latosinsky - University of Manitoba

February 2006

Topics
1. Clinical Topic: Decision aids for patients considering options aftecting cancer outcomes
2. Methodological Topic: Decision Aid
 
Questions
  1. What is the objective of the decision aid?
  2. Is there a need for a decision aid?
  3. Were all treatment options considered in the decision aid and were they appropriate?
  4. What were the outcomes measured?
  5. Were the outcomes appropriate and complete?
  6. What is the conclusion?
  7. Does the evidence support the conclusion?
  8. Will the decision aid be useful in your practice?
Articles

1. Effect of a decision aid on knowledge and treatment decision making for breast cancer surgery; Whelan T, Levine M, Willan A, et al; Effect of a Decision Aid on Knowledge and Treatment Decision Making for Breast Cancer Surgery. A Randomized Trial. JAMA 2004; 292(4): 435-41

2. Decision aids for patients consdiering options affecting cancer outcomes; OíConnor AM, Fieset V, DeGrasse C, et al; Decision Aids for Patients Considering Options Affecting Cancer Outcomes: Evidence of Efficacy and Policy Implications Monogr Natl Cancer Inst 1999; 25: 67-80
 
Reviews
Clinical Review (Can): Dave McCready - University of Toronto
Clinical Review (US): Armando Giuliano - University of California (LA)
Methodological Review: Harry Heteleff - Dalhousie University

January 2006

Topics
1. Clinical Topic: Timing of elective colectomy in diverticulitis
2. Methodological Topic: Decision Analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Were all of the realistic clinical strategies compared?
  3. Were all clinically relevant outcomes consdiered?
  4. Was an explicit and sensible process used to identify, select and combine the evidence into probabilities?
  5. Were the utilities obtained in an explicit and sensible way from credible sources?
  6. Was the potential impact of any uncertainty in the evidence determined in the baseline analysis?
  7. Does one stategy result in a clincally important gain for patients?
  8. How strong is the evidence used in the analysis?
  9. Could the uncertainty in the evidence change the results?
  10. Doe the probability estimates fit my patients' clinical features?
  11. Do the utlities reflect how my patients would value the outcomes of the decision?
  12. State the conclusion. Have the authors addressed the question?
  13. Does the evidence support the conclusion?
Articles

1. Timing of elective colectomy in diverticulitis; Salem L, Veenstra D, Sullivan SD, Flum DR; The Timing of Elective Colectomy in Diverticulitis: A Decision Analysis. J Am Coll Surg 2004; 199(6): 904-12

2. How to use a clinical decision analysis (a); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group. Usersí Guides to the Medical Literature. VII. How to Use a Clinical Decision Analysis. JAMA 1995; 273(16): 1292-95

3. How to use a clinical decision analysis (b); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group. Usersí Guides to the Medical Literature. VII. How to Use a Clinical Decision Analysis. JAMA 1995; 273(20): 1610-13
 
Reviews
Clinical Review (Can): Terry Phang - University of British Columbia
Clinical Review (US): Steve Wexner - Cleveland Clinic
Methodological Review: Robin McLeod - University of Toronto

December 2005

Topics
1. Clinical Topic: Value of prohylactic drainage in GI surgery
2. Methodological Topic: Meta-analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Did the review explicitly address a sensible clinical question?
  3. Was the search for relevant studies detailed and exhaustive?
  4. Were the primary studies of high methodologic quality?
  5. Were assessments of studies reproducible?
  6. Were the results similar from study to study?
  7. What are the overall results of the review?
  8. How precise were the results?
  9. Were the clinically important outcomes considered?
  10. Are the benefits worth the costs and potential risks?
  11. State the conclusion. Have the authors addressed the question?
  12. Does the evidence suppport the conclusion?
Articles

1. Evidence based value of prophylactic drainage in GI surgery; Petrowsky H, Demartines N, Rolusson V, Clavien PA; Evidence-based Value of Prophylactic Drainage in Gastrointestinal Surgery. A Systematic Review and Meta-analysis. Ann Surg 2004; 240(6): 1074-85

2. How to use an article on a systematic review and meta-analysis; Bhandari M, Devereaux PJ, Montore V, et al; for the Evidence Based Surgery Working Group. Usersí Guide to Surgical Literature: How to Use a Systematic Review and Meta-analysis. CJS 2004; 47(1): 60-67 
 
Reviews
Clinical Review (Can): Bill Fitzgerald - St. Anthony NL
Clinical Review (US): Michael Sarr - Mayo Clinic College of Medicine
Methodological Review: Mark Taylor - University of Manitoba

November 2005

Topics
1. Clinical Topic: Lap. assisted colectomy vs. open colectomy for colon ca
2. Methodological Topic: Quality of Life
 
Questions
  1. What is the clinical question being addressed?
  2. Have the investigators measured aspects of patients' lives that patients consider important?
  3. Did the HRQL Instruments work in the way they are supposed to?
  4. Are there important aspects of HRQL that have been omitted?
  5. If there were trade-offs between quality and quantity of life, or an economic evaluation, have the investigators used the right measures?
  6. What was the magnitude of effect on HRQL?
  7. Will the information from the study help me inform my patients?
  8. Did the study design simulate clinical practice?
  9. State the conclusion. Have the authors addressed the question posed?
  10. Does the evidence support the conclusion?
Articles

1. Quality of life outcomes following laparoscopic assisted colectomy vs. open colectomy for colon cancer; Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G, for the Clinical Outcomes of Surgical Therapy (COST) Study Group. Short-term Quality-of-Life Outcomes Following Laparoscopic-Assisted Colectomy vs. Open Colectomy for Colon Cancer. A Randomized Trial. JAMA 2002; 287(3): 321-328

2. How to use articles about health related quality of life; Guyatt, GH, Naylor CD, Juniper E, Heyland DK, Jaeschke R, Cook DJ, for the Evidence-Based Medicine Working Group: Usersí Guide to the Medical Literature. XII. How to Use Articles About Health-Related Quality of Life. JAMA 1997; 277(15):1232-37
 
Reviews
Clinical Review (Can): Don Buie - University of Calgary
Clinical Review (US): Jim Fleshman - University of Washington
Methodological Review: Karen Brasel - Medical College of Wisconsin

October 2005

Topics
1. Clinical Topic: Primary hyperparathyroidism
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized and concealed?
  3. Were all patients who entered the trial properly accounted for?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Were the study patients similar to my patients?
  9. Were the measured outcomes clinically relevant?
  10. Were all clinically important outcomes considered?
  11. Are my surgical skills similar to those of the study surgeons?
  12. State the conclusion. Have the authors addressed the question?
  13. Does the evidence support the conclusion?
  14.  
Articles

1. Mild asymptomatic primary hyperparathryoidism; Talpos GB, Bone III HG, Kleerekoper M, et al; Randomized Trial of Parathyroidectomy in Mild Asymptomatic Primary Hyperparathyroidism: Patient Description and Effects on the SF-36 Health Survey.  Surgery 2000; 128: 1031-21

2. How to use an article evaluating surgical interventions; Urshel JD, Goldsmith CH, Tandan VR, Miller JD; for the Evidence-Based Surgery Working Group. Usersí Guide to Evidence-Based Surgery: How to Use an Article Evaluating Surgical Interventions. CJS 2001; 44(2): 95-100
 
Reviews
Clinical Review (Can): Sam Wiseman - University of British Columbia
Clinical Review (US): Quan-Yong Duh - Ujniversity of California (San Francisco)
Methodological Review: Jeffrey Barkun - McGill Unviersity

May 2005

Topics
1. Clinical Topic: Fibrin glue vs. conventional treatment for anal fistula
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusion?
  4. Was there adequate blinding of patients, their clinicians and study personnel?
  5. Were the groups similar at the start of the trial?
  6. Was there adequate standardization of the surgical procedure?
  7. How large and precise was the treatment effect?
  8. Are the procedures adequately described so that they can be used in your own patient care?
  9. Are the surgical techniques that were compared still relevant or have they been supplanted by newer procedures?
  10. Were all clinically important outcomes considered?
  11. Are the likely treatment benefits worth the potential harm and costs?
  12. State the conclusion. Have the authors addressed the question?
  13. Does the evidence support the conclusion?
Articles

1. The use of fibrin glue vs. conventional treatment for anal fistula; Lindsey I, Smilgin-Humphreys MM, Cunningham C, et al; A Randomized, Controlled Trial of Fibrin Glue vs. Conventional Treatment for Anal Fistula. DCR 2002; 45 (12): 1608-15

2. Issues in surgical randomized controlled trials; McLeod, RS: Issues in Surgical Randomized Controlled Trials. World J. Surg 1999; 23: 1210-1214   * You may want to refer to the methodology article on treatment effectiveness from the Oct. 2004 package
 
Reviews
Clinical Review (Can): Bernie McIntyre - Dalhousie University
Clinical Review (US): David Schoetz - Tufts University
Methodological Review: Andy Kirkpatrick - University of Calgary

April 2005

Topics
1. Clinical Topic: Barrett's esophagus
2. Methodological Topic: Prognosis/Natural History
 
Questions
  1. What is the clinical question being addressed?
  2. Was there a representive and well-defined sample of patients at a similar point int he course of the disease?
  3. Was follow-up sufficiently long and complete?
  4. Were objective and unbiased outcome criteria used?
  5. Was there adjustment for important prognostic factors?
  6. How large is the likelihood of the outcome event(s) in a specified period of time?
  7. How precise are the estimates of likelihood?
  8. Will the results help me in caring for my patients?
  9. Will the results lead directly to selecting or avoiding therapy?
  10. Are the results useful for reassuring or counseling patients?
  11. State the conclusion. Have the authors addressed the question?
  12. Does the evidence support the conclusion?
Articles

1. Mortality in Barrett's esophagus; Anderson LA, Murray LJ, Murphy SJ, et al; Mortality in Barrettís Oesophagus: Results from a Population Based Study. Gut 2003; 52: 1081-84 (no link available)

2. How to use an article about prognosis; Laupacis A, Wells G, Richardson WS, Tugwell P, for The Evidence-Based Working Group: Users' Guides to the Medical Literature. V. How to Use an Article About Prognosis. JAMA 1994; 272: 234-237
 
Reviews
Clinical Review (Can): Larry Tan - University of Manitoba
Clinical Review (US): Jeffrey Peters - University of Rochester School of Medicine and Dentistry
Methodological Review: Harry Heteleff - Dalhousie University

March 2005

Topics
1. Clinical Topic: Morbid obesity
2. Methodological Topic: Decision Analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Were all the realistic clinical strategies compared?
  3. Were all clinically relevant outcomes considered?
  4. Was an explicit and sensible process used to identify, select and combine the evidence into probabilities?
  5. Were the utilities obtained in an explicit and sensible way from credible sources?
  6. Was the potential impact of any uncertainty in the evidence determined in the baseline analysis?
  7. Does one strategy result in a clinically important gain for patients?
  8. How strong is the evidence used in the analysis?
  9. Could the uncetainty in the evidence change the results?
  10. Do probability estimates fit my patient's clinical features?
  11. Do the utilities reflect how my patients would value the outcomes of the decision?
  12. State the conclusion. Have the authors addressed the question?
  13. Does the evidence support the conclusion?
Articles

1. Comparison of diet and exercise vs. gastric bypass surgery for morbid obesity; Patterson EJ, Urbach DR, Swanstrom LL; A Comparison of Diet and Exercise Therapy Versus Laparoscopic Roux-en-Y Gastric Bypass Surgery for Morbid Obesity: A Decision Analysis Model. J Am Coll Surg 2003; 196 (3): 379-84

2. How to use a clinical decision analysis (a); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group. Usersí Guides to the Medical Literature. VII. How to Use a Clinical Decision Analysis. JAMA 1995; 273(16): 1292-95

3. How to use a clinical decision analysis (b); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group. Usersí Guides to the Medical Literature. VII. How to Use a Clinical Decision Analysis. JAMA 1995; 273(20): 1610-13
 
Reviews
Clinical Review (Can): Dave Pace - Memorial University
Clinical Review (Can): Barbara Bass - University of Maryland
Methodological Review: Mark Taylor - University of Manitoba

February 2005

Topics
1. Clinical Topic: Hepatic metastasectomy
2. Methodological Topic: Economic Analysis
 
Questions
  1. What is the clincial question being addressed?
  2. Did the analysis provide a full economic comparison of health care strategies?
  3. Was a broad enough viewpoint adopted?
  4. Were all the relevant clinical strategies compared?
  5. Were the costs and outcomes properly measured and valued?
  6. Was clinical effectiveness established?
  7. Were costs measured accurately?
  8. Were data on costs and outcomes appropriately integrated?
  9. Was appropriate allowance made for uncertainties in the analysis?
  10. What were the incremental costs and outcomes of each strategy?
  11. Do increments costs and outcomes differ between subgroups?
  12. Could my patients expect similar health outcomes?
  13. State the conclusion. Have the authors addressed the question posed?
  14. Does the evidence support the conclusion?
Articles

1. Cost effectiveness of hepatic metastasectomy in patients with meatastatic colorectal cancer; Gazelle GS, Hunink MGM, Kuntz KM, et al; Cost-Effectiveness of Hepatic Metastasectomy in Patients with Metastatic Colorectal Carcinoma. Annals of Surgery 2003; 237 (4): 544-55

2. How to use an article on economic analysis (a); Drummond MF, Richardson WS, O'Brien BJ, et al, for the Evidence-Based Medicine Working Group.  Users' Guides to the Medical Literature. XIII. How to Use an Article on Economic Analysis.  JAMA 1997; 277(19): 1552-1557

3. How to use an article about economic analysis (b); O'Brein BJ, Heyland D, Richardson WS, et al, for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature. XIII. How to Use an Article on Economic Analysis.  JAMA 1997; 277(22): 1802-1806
 
Reviews
Clinical Review (Can): Sharif Hannah - University of Toronto
Clinical Review (US): Yuman Fong - Cornell University
Methodological Review: Mark Taylor - University of Manitoba

January 2005

Topics
1. Clinical Topic: CT mesenteric ischemia
2. Methodological Topic: Diagnostic Tests
 
Questions
  1. What is the clinical question being addressed?
  2. Is there an independent, blind comparison with a reference standard?
  3. Does the study sample include an appropriate spectrum of patients to which the diagnostic test is applied?
  4. Do the results of the test being evaluated influence the decision to perform the reference standard test?
  5. Are the methods for performing the test described in sufficient detail to permit replication?
  6. Are likelihood ratios for the test results presented, or is the data necessary for their calculation included?
  7. Will the reproducibility of the test result and its interpretation be satisfactory in my setting?
  8. Are the results applicable to my patient?
  9. Will the results change my management?
  10. Will patients be better off as a result of the test?
  11. State the conclusion. Have the authors addressed the question?
  12. Does the evidence support the conclusion?
Articles

1. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia; Kirkpatrick IDC, Kroeker MA, Greenberg HM; Biphasic CT with Mesenteric CT Angiography in the Evaluation of Acute Mesenteric Ischemia: Initial Experience. Radiology 2003; 229 (1): 91-98

2. How to use an artcile about a diagnostic test; Archibald S, Bhandari M, Thoma A, for the Evidence-Based Surgery Working Group. Usersí Guides to the Surgical Literature: How to Use an Article about a Diagnostic Test. CJS 2001; 44(1): 17-23
 
Reviews
Clinical Review (Can): Tom Lindsay - University of Toronto
Clinical Review (Can): Martin O'Malley - University of Toronto
Methodological Review: Robin McLeod - University of Toronto

December 2004

Topics
1. Clinical Topic: Screening mammography
2. Methodological Topic: Guidelines
 
Questions
  1. What is the clinical question being asked?
  2. Were all important options and outcomes considered?
  3. Was an explicit and sensible process used to identify, select and combine evidence?
  4. Was an explicit and sensible process used to consider the relative value of different outcomes?
  5. Is the guideline likely to account for important recent developments?
  6. Has the guideline been subjected to peer review and testing?
  7. Are practical clinically important recommendations made?
  8. How strong are the recommendations?
  9. What is the impact of uncertainty associated with the evidence and values used in the guidelines?
  10. Is the primary objective of the guidelines consistent with your objective?
  11. Are the recommendations applicable to your patients?
  12. State the conclusion. Have the authors addressed the question?
  13. Does the evidence support the conclusion?
Articles

1. Screening mammorgraphy among women aged 40-49 years at average risk for breast ca; Ringash J, with the Canadian Task Force on Preventive Health Care; Preventive Health Care, 2001 Update: Screening Mammography Among Women Aged 40-49 years at Average Risk of Breast Cancer. CMAJ 2001; 164 (4): 469-76

2. How to use clinical practice guidelines (a); Hayward RSA, Wilson MC, Tunis SR, Bass EB, Guyatt G, for the Evidence-Based Medicine Working Group. Users' Guide to the Medical Literature. VIII How to use Clinical Practice Guidelines. JAMA 1995;274(7): 570-74

3. How to use clinical practice guidelines (b); Wilson MC, Hayward RSA, Tunis SR, Bass EB, Guyatt G, for the Evidence-Based Medicine Working Group.  Users' Guide to the Medical Literature. VIII How to Use Clinical Practice Guidelines.  JAMA 1995; 274(20):1630-32
 
Reviews
Clinical Review (Can): Carman Ciacomantonio - Dalhousie University
Clinical Review (US): Kelly Hunt - University of Texas
Methodological Review: Steven Latosinsky - University of Manitoba

November 2004

Topics
1. Clinical Topic: Preoperative fasting
2. Methodological Topic: Meta-analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Did the review explicitly address a sensible clinical question?
  3. Was the search for relevant studies detailed and exhaustive?
  4. Were the primary studies of high methodologic quality?
  5. Were the assessments of studies reproducible?
  6. Were the results similar from study to study?
  7. What are the overall results of the review?
  8.  How precise were the results?
  9. Were the clinically important outcomes considered?
  10. Are the benefits worth the costs and potential risks?
  11. State the conclusion. Have the authors addressed the question?
  12. Does the evidence support the conclusion?
Articles

1. Preoperative fasting for adults to prevent perioperative complications; Brady M, Kinn S, Stuart P; Preoperative Fasting for Adults to Prevent Perioperative Complications. The Cochrane Library Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd. (no link available)

2. How to use an article on a systematic review and meta-analysis; Bhandari M, Devereaux PJ, Montore V, et al; for the Evidence Based Surgery Working Group. Usersí Guide to Surgical Literature: How to Use a Systematic Review and Meta-analysis. CJS 2004; 47(1): 60-67 
 
Reviews
Clinical Review (Can): Bill Fitzgerald - St. Anthony NL
Clinical Review (US): Michael Sarr - Mayo Clinic College of Medicine
Methodological Review: Robin McLeod - University of Toronto

October 2004

Topics
1. Clinical Topic: Bile duct stones
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized and concealed?
  3. Were all patients who entered the trial properly accounted for?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Were the study patients similar to my patients?
  9. Were the measured outcomes clinically relevant?
  10. Were all clinically important outcomes considered?
  11. Are my surgical skills similar to those of the study surgeons?
  12. State the conclusion. Have the authors addressed the question?
  13. Does the evidence support the conclusion?
Articles

1. Wait & see policy or laparoscopic cholecystecomy after endoscopic sphincterotomy for bile duct stones; Boerma D, Bauws EJ, Keulemans YA et al; Wait-and-See Policy or Laparoscopic Cholecystectomy after Endoscopic Sphincterotomy for Bile-Duct Stones: A Randomised Trial. Lancet 2002; 360: 761-65

2. How to use an article about evaluating surgical interventions; Urschel JD, Goldsmith CH, Tandan VR, Miller JD; for the Evidence-Based Surgery Working Group. Usersí Guide to Evidence-Based Surgery: How to Use an Article Evaluating Surgical Interventions CJS 2001; 44(2): 95-100
 
Reviews
Clinical Review (Can): Elijah Dixon - University of Calgary
Clinical Review (US): Steve Strasberg - Washington School of Medicine
Methodological Review: Jeffrey Barkun - McGill Unviersity

May 2004

Topics
1. Clinical Topic: Peripheral vascular disease
2. Methodological Topic: Decision Analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Were all of the realistic clinical strategies compared?
  3. Were all clinically relevant outcomes considered?
  4. Was an explicit and sensible process used to identify, select and combine the evidence into probabilities?
  5. Were the utilities obtained in an explicit and sensible way from credible sources?
  6. Was the potential impact of any uncertainty in the evidence determined in the baseline analysis?
  7. Does one strategy result in a clinically important gain for patients?
  8. How strong is the evidence used in the analysis?
  9. Could the uncertainty in the evidence change the results?
  10. Do the probability estimates fit my patients' clinical features?
  11. Do the utilities reflect how my patients would value the outcomes of the decision?
  12. State the conclusion. Have the authors addressed the question?
  13. Does the evidence support the conclusion?
Articles

1. The effect of perioperative aspirin therapy in peripheral vascular surgery; Neilipovitz DT, Bryson GL, Nichol G, The Effect of Perioperative Aspirin Therapy in Peripheral Vascular Surgery: a Decision Analysis. Anesth Analg. 2001; 93: 573-80

2. How to use a clinical decision analysis (a); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group. Usersí Guides to the Medical Literature. VII. How to Use a Clinical Decision Analysis. JAMA 1995; 273(16): 1292-95

3. How to use a clinical decision analysis (b); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group. Usersí Guides to the Medical Literature. VII. How to Use a Clinical Decision Analysis. JAMA 1995; 273(20): 1610-13
 
Reviews
Clinical Review (Can): George Louridas - University of Manitoba
Methodological Review: Claudio Cina - McMaster University

April 2004

Topics
1. Clinical Topic: Splenic trauma
2. Methodological Topic: Guidelines
 
Questions
What impact (negative or positive) did the following factors have in the implementation of the clinical practice guidelines (CPGs) on the Management of Pediatric Splenic Trauma:
  1. The strength of the evidence used to develop and maintain the CPGs?
  2. The technological advancements utilized to develop and maintain the CPGs?
  3. The technological advancements utilized to implement the CPGs?
  4. Information sharing and cooperation amongst groups developing CPGs on the same topic?
  5. Involvement of different stakeholders in the development and implementation of CPGs?
  6. The use of report cards or disincentives to increase compliance with CPGs?
  7. Use of CPGs to restrict legitimate health care choices or limit health care costs?
Articles

1. Compliance with Evidence-based guidelines in children with isolated spleen or liver injury; Stylianos S and the APSA Liver/Spleen Trauma Study Group. Compliance with Evidence-Based Guidelines in Children with Isolated Spleen or Liver Injury: A Prospective Study. J Pediatr Surg 2002; 37(3): 453-56 (no link available)

2. Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury; Stylianos S and the APSA Liver/Spleen Trauma Study Group. Evidence-Based Guidelines for Resource Utilization in Children with Isolated Spleen or Liver Injury. J Pediatr Surg 2000; 35(2): 164-69 (no link available)

3. Imporving clinical practice guidelines for the 21st century; Browman, GP. Improving Clinical Practice Guidelines for the 21st Century. Intl J of Technology Assessment in Health Care 2000; 16(4): 959-68 (no link available)
 
Reviews
Clinical Review (Can): Eric Webber - University of British Columbia
Methodological Review: Robin McLeod - University of Toronto

March 2004

Topics
1. Clinical Topic: Gastric ca
2. Methodological Topic: Guidelines
 
Questions
  1. What is the clinical question being asked?
  2. Were all important options and outcomes considered?
  3. Was an explicit and sensible process used to identify, select and combine evidence?
  4. Was an explicit and sensible process used to consider the relative value of different outcomes?
  5. Is the guideline likely to account for important recent developments? Has the guideline been subjected to peer review and testing?
  6. Are practical clinically important recommendations made?
  7. How strong are the recommendations?
  8. What is the impact of uncertainty associated with the evidence and values used in the guidelines?
  9. Are the recommendations applicable to your patients?
Articles

1. Neoadjuvant or adjuvant therapy for resectable gastric cancer; Earle CC, Maroun J, Zuraw L, et al: Neoadjuvant or Adjuvant Therapy for Resectable Gastric Cancer? A Practice Guideline. Can J Surg. 2002; 45(6): 438-48

2. How to use clinical practice guidelines (a); Earle CC, Maroun J, Zuraw L, et al: Neoadjuvant or Adjuvant Therapy for Resectable Gastric Cancer? A Practice Guideline. Can J Surg. 2002; 45(6): 438-48

3. How to use clinical practice guidelines (b); Wilson MC, Hayward RSA, Tunis SR, Bass EB, Guyatt G, for the Evidence-Based Medicine Working Group. Users' Guide to the Medical Literature. VIII How to Use Clinical Practice Guidelines. JAMA 1995; 274(20):1630-32
 
Reviews
Clinical Review (Can): Debra Wirtzfeld - Memorial University
Methodological Review: Robin McLeod - University of Toronto

February 2004

Topics
1. Clinical Topic: Penetrating colon injuries
2. Methodological Topic: Meta-analysis
 
Questions
  1. What is the clinical question being addressed?
  2. What were the criteria used to select articles for inclusion
  3. Is it unlikely that important relevant studies were missed?
  4. Was the validity of the included studies appraised?
  5. Were assessments of the studies reproducible?
  6. Were the results similar from study to study?
  7. What are the overall results of the overview? How precise were the results?
  8. Were all clinically important outcomes considered?
  9. Are the benefits worth the harms and costs?
  10. State the conclusion. Have the authors addressed the question?
  11. Does the evidence support the conclusion?
Articles

1. Primary repair for penetrating colon injuries; Nelson R, Singer M: Primary Repair for Penetrating Colon Injuries (Cochrane Review). The Cochrane Library 2003; Issue (1) (no link available)

2. How to use an article on overview; Oxman AD, Cook DJ, Guyatt GH, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. VI. How to Use an Overview. JAMA 1994; 272: 1367-1371
 
Reviews
Clinical Review (Can): Sarvesh Logsetty - University of Alberta
Methodological Review: Mark Taylor - University of Manitoba

January 2004

Topics
1. Clinical Topic: Adenocarcinoma esophagus
2. Methodological Topic: Number Needed to Treat/Confidence Intervals/Equivalence
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusions?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Can the results be applied to my patient care?
  9. Were all clinically important outcomes considered?
  10. Are the likely treatment benefits worth the potential harm and costs?
  11. State the conclusion. Have the authors addressed the question?
  12. Is the evidence strong enough to conclude that the outcome is similar irrespective of the type of surgical procedure in patients with adenocarcinoma of the esophagus?
Articles

1. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma; Hulscher JBF, Van Sandick JW, De Boer AGEM, et al: Extended Transthoracic Resection Compared with Limited Transhiatal Resection for Adenocarcinoma of the Esophagus. N Engl J Med 2002; 347(21): 1662-69

2. Interpreting study results: confidence intervals; Guyatt G, Jaeschke R, Heddle N, Cook D, Shannon H, Walter S: Basic Statistics for Clinicians: Interpreting Study Results: Confidence Intervals. Can Med Assoc J 1995; 152 (2): 169-173
 
Reviews
Clinical Review (Can): Denise Ouellette - University of Montreal
Methodological Review: Harry Heteleff - Dalhousie University

December 2003

Topics
1. Clinical Topic: Colon ca
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized and concealed?
  3. Were all patients who entered the trial properly accounted for?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Were the study patients similar to my patients?
  9. Were the measured outcomes clinically relevant?
  10. Were all clinically important outcomes considered?
  11. Are my surgical skills similar to those of the study surgeons?
  12. State the conclusion. Have the authors addressed the question?
  13. Does the evidence support the conclusion?
Articles

1. Laparoscopic assisted colectomy vs. open colectomy for treatment of non-metastatic colon cancer; Lacy AM, Garcia-Valdecasas JC, Delgado S, et al: Laparoscopy-Assisted Colectomy Versus Open Colectomy for Treatment of Non-Metastatic Colon Cancer: a Randomised Trial. Lancet 2002; 359: 2224-29

2. How to use an article evaluating surgical interventions; Urschel JD, Goldsmith CH, Tandan VR, Miller JD; for the Evidence-Based Surgery Working Group. Usersí Guide to Evidence-Based Surgery: How to Use an Article Evaluating Surgical Interventions CJS 2001; 44(2): 95-100
 
Reviews
Clinical Review (Can): Hartley Stern - University of Ottawa
Methodological Review: Carole Richard - University of Montreal

November 2003

Topics
1. Clinical Topic: MRCP
2. Methodological Topic: Diagnostic Tests
 
Questions
  1. What is the clinical question being addressed?
  2. Is there an independent, blind comparison with a reference standard?
  3. Does the study sample include an appropriate spectrum of patients to which the diagnostic test is to be applied?
  4. Do the results of the test being evaluated influence the decision to perform the reference standard test?
  5. Are the methods for performing the test described in sufficient detail to permit replication?
  6. Are likelihood ratios for the test results presented, or is the data necessary for their calculation included?
  7. Will the reproducibility of the test result and its interpretation be satisfactory in my setting?
  8. Are the results applicable to my patient?
  9. Will the results change my management?
  10. Will patients be better off as a result of the test?
  11. State the conclusion. Have the authors addressed the question?
  12. Does the evidence support the conclusion?
Articles

1. Efficacy of Diagnosis of Mechanical Cholestatsis by MRC; Urban M, Holzer B, Sebesta C, et al: Efficacy of Diagnosis of Mechanical Cholestatsis by Magnetic Resonance Cholangiography. World J. Surg. 2002; 26: 353-58

2. How to use an artcile about a diagnostic test; Archibald S, Bhandari M, Thoma A, for the Evidence-Based Surgery Working Group. Usersí Guides to the Surgical Literature: How to Use an Article about a Diagnostic Test. CJS 2001; 44(1): 17-23
 
Reviews
Clinical Review (Can): Elijah Dixon - University of Calgary
Methodological Review: Jeffrey Barkun - McGill Unviersity

October 2003

Topics
1. Clinical Topic: Retained sponges
2. Methodological Topic: Causation/Risk Factors
 
Questions
  1. What is the clinical question being addressed?
  2. Were there clearly identified comparison groups that were similar with respect to important determinants of outcome other than the one of interest?
  3. Were the exposures and outcomes measured in the same way in the groups being compared?
  4. Was follow-up sufficiently long and complete?
  5. Is the temporal relationship correct?
  6. Is there a dose-response gradient?
  7. How strong is the association between exposure and outcome?
  8. How precise is the estimate of the risk?
  9. Are the results applicable to my practice?
  10. What is the magnitude of the risk?
  11. Should I attempt to stop the exposure?
  12. State the conclusion. Have the authors addressed the question?
  13. Does the evidence support the conclusion?
  14. Can the results of this study lead to improved outcome in your setting?
Articles

1. Risk factors for retained sponges after surgery; Gawande AA, Studdert DM, Orav EJ, et al: Risk Factors for Retained Instruments and Sponges after Surgery. N Engl J Med 2003;348:229-35

2. How to use an article about harm; Mitchell L, Walter S, Lee H, Haines T, Holbrook A, Moyer V, for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature. IV. How to Use an Article about Harm. JAMA 1994; 271(20): 1615-19
 
Reviews
Clinical Review (Can): John Bohnen - University of Toronto
Methodological Review: Robin McLeod - University of Toronto

May 2003

Topics
1. Clinical Topic: Common bile duct injury
2. Methodological Topic: Quality of Life
 
Questions
  1. What is the clinical question being addressed?
  2. Have the investigators measured aspects of patients' lives that patients consider important?
  3. Did the HRQL Instruments work in the way they are supposed to?
  4. Are there important aspects of HRQL that have been omitted?
  5. If there were trade-offs between quality and quantity of life, or an economic evaluation, have the investigators used the right measures?
  6. What was the magnitude of effect on HRQL?
  7. Will the information from the study help me inform my patients?
  8. Did the study design simulate clinical practice?
  9. State the conclusion. Have the authors addressed the question posed?
Articles

1. Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy; Boermaa D, Rauws EA, Keulemans YCA et al. Impaired Quality of Life 5 Years After Bile Duct Injury During Laparoscopic Cholecystectomy. Annals of Surgery 2001; 234(6): 750-7

2. Outcome research: what to measure; Wright JG: Outcomes Research: What to Measure. World J Surg. 1999;23:1224-26

3. How to use articles about health related quality of life; Guyatt GH, Naylor CD, Juniper E, Heyland DK, Jaeschke R, Cook DJ, for the Evidence-Based Medicine Working Group: User's Guide to the Medical Literature. XII. How to Use Articles About Health-Related Quality of Life. JAMA 1997; 277 (15): 1232-1237
 
Reviews
Clinical Review (Can): Richard Hart - University of Toronto
Methodological Review: Mark Taylor - University of Manitoba

April 2003

Topics
1. Clinical Topic: Esophageal Ca
2. Methodological Topic: Causation/Risk Factors
 
Questions
  1. What is the clinical question being addressed?
  2. Were there clearly identified comparison groups that were similar with respect to important determinants of outcome other than the one of interest?
  3. Were the exposures and outcomes measured in the same way in the groups being compared?
  4. Was follow-up sufficiently long and complete?
  5. Is the temporal relationship correct?
  6. Is there a dose-response gradient?
  7. How strong is the association between exposure and outcome?
  8. How precise is the estimate of the risk?
  9. Are the results applicable to my practice?
  10. What is the magnitude of the risk?
  11. Should I attempt to stop the exposure?
  12. State the conclusion. Have the authors addressed the question posed?
  13. Does the evidence support the conclusion?
Articles

1. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma; Lagergren J, Bergstrom R, Lindgren A, Nyrťn O. Symptomatic Gastroesophageal Reflux as a Risk Factor for Esophageal Adenocarcinoma. NEJM 1999; 340(11): 825-31

2. How to use an article about harm; Mitchell L, Walter S, Lee H, Haines T, Holbrook A, Moyer V, for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature. IV. How to Use an Article about Harm. JAMA 1994; 271(20): 1615-1619
 
Reviews
Clinical Review (Can): Gail Darling - University of Toronto
Methodological Review: Harry Heteleff - Dalhousie University

March 2003

Topics
1. Clinical Topic: Bowel Prep
2. Methodological Topic: Meta-analysis
 
Questions
  1. What is the clinical question being addressed?
  2. What were the criteria used to select articles for inclusion
  3. Is it unlikely that important relevant studies were missed?
  4. Was the validity of the included studies appraised?
  5. Were assessments of the studies reproducible?
  6. Were the results similar from study to study?
  7. What are the overall results of the overview? How precise were the results?
  8. Were all clinically important outcomes considered?
  9. Are the benefits worth the harms and costs?
  10. State the conclusion. Have the authorsí addressed the question posed? Does the evidence support the conclusion?
Articles

1. Preoperative bowel cleansing; Guenaga KF. Preoperative Bowel Cleansing. Seminars in Colon & Rectal Surgery. 2002; 13(1): 53-61 (link not available)

2. How to use an article on overview; Oxman AD, Cook DJ, Guyatt GH, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. VI. How to Use an Overview. JAMA 1994; 272: 1367-1371
 
Reviews
Clinical Review (Can): Ben Yip - University of Manitoba
Methodological Review: Robin McLeod - University of Toronto

February 2003

Topics
1. Clinical Topic: Hospital volume and surgical mortatlity
2. Methodological Topic: Health Services Research
 
Questions
  1. What is the clinical question being addressed?
  2. How accurate is the database?
  3. How were the volume groups determined?
  4. Is the primary outcome measure appropriate?
  5. How do patients compare among volume groups and were differences considered in the analysis?
  6. What was the magnitude of the results?
  7. How precise was the estimate of the treatment effect?
  8. Will the results help me?
  9. State the conclusion. Have the authors addressed the question posed?
  10. Does the evidence support the conclusion?
Articles

1. Hospital volume and surgical mortality; Birkmeyer JD, Siewers AE, Finlayson EVA, et al: Hospital Volume and Surgical Mortality in the United States. NEJM 2002; 346(15): 1128-37

2. How to use an article reporting population based volume-outcome relationships in surgery; Hong D, Tandan VR, Goldsmith CH, Simunovic M, for the Evidence-Based Surgery Working Group. Users' Guide to the Surgical Literature: How to Use an Article Reporting Population Based Volume-Outcome Relationships in Surgery. CJS 2002; 45(2): 109-15
 
Reviews
Clinical Review (Can): Donna Maziak - University of Ottawa
Methodological Review: Claudio Cina - McMaster University

January 2003

Topics
1. Clinical Topic: DCIS/Breast ca
2. Methodological Topic: Guidelines
 
Questions
  1. What is the clinical question being asked?
  2. Were all important options and outcomes considered?
  3. Was an explicit and sensible process used to identify, select and combine evidence?
  4. Was an explicit and sensible process used to consider the relative value of different outcomes?
  5. Is the guideline likely to account for important recent developments? Has the guideline been subjected to peer review and testing?
  6. Are practical clinically important recommendations made?
  7. How strong are the recommendations?
  8. What is the impact of uncertainty associated with the evidence and values used in the guidelines?
  9. Are the recommendations applicable to your patients?
Articles

1. Clinical practice guidelines for breast cancer; The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer: The Management of Ductal Carcinoma in Situ (DCIS). Can Med Assoc J 2001; 165(7)

2. Supplement: Clinical practice guidelines for breast ca; The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer: The Management of Ductal Carcinoma in Situ (DCIS). Can Med Assoc J 1998; 158 (3 Suppl): S27-34

3. Development of clinical practice guidelines; Brouwers MC, Browman GP: Development of Clinical Practice Guidelines: Surgical Perspective. World J Surg. 1999;23:1236-1241

4. How to use clinical practice guidelines (a); Hayward RSA, Wilson MC, Tunis SR, Bass EB, Guyatt G, for the Evidence-Based Medicine Working Group. Users' Guide to the Medical Literature. VIII How to use Clinical Practice Guidelines. JAMA 1995;274(7): 570-74

5. How to use clinical practice guidelines (b); Wilson MC, Hayward RSA, Tunis SR, Bass EB, Guyatt G, for the Evidence-Based Medicine Working Group. Users' Guide to the Medical Literature. VIII How to Use Clinical Practice Guidelines. JAMA 1995; 274(20):1630-32
 
Reviews
Clinical Review (Can): Hugh Scarth - Dalhousie University
Methodological Review: Robin McLeod - University of Toronto

December 2002

Topics
1. Clinical Topic: U/S in trauma
2. Methodological Topic: Diagnostic Tests
 
Questions
    1. What is the clinical question being asked?
    2. Is there an independent, blind comparison with a reference standard?
    3. Does the study sample include an appropriate spectrum of patients to which the diagnostic test is to be applied?
    4. Do the results of the test being evaluated influence the decision to perform the reference standard test?
    5. Are the methods for performing the test described in sufficient detail to permit replication?
    6. Are likelihood ratios for the test results presented, or is the data necessary for their calculation included?
    7. Will the reproducibility of the test result and its interpretation be satisfactory in my setting?
    8. Are the results applicable to my patient?
    9. Will the results change my management?
    10. Will patients be better off as a result of the test?
    11. State the conclusion. Have the authors addressed the question posed?
    12. Does the evidence support the conclusion?
Articles

1. Surgeon performed ultrasound in trauma cases; Rozycki GS, Ballard RB, Feliciano DV, et al: Surgeon-Performed Ultrasound for the Assessment of Truncal Injuries. Annals of Surgery 1998; 228(4): 557-67

2. How to use an article about a diagnostic test; Archibald S, Bhandari M, Thoma A, for the Evidence-Based Surgery Working Group. Users' Guides to the Surgical Literature: How to Use an Article About a Diagnostic Test. CJS 2001; 44(1): 17-23
 
Reviews
Clinical Review (Can): Andy Kirkpatrick - University of Calgary
Methodological Review: Harry Heteleff - Dalhousie University

November 2002

Topics
1. Clinical Topic: ICU
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being asked?
  2. Was the assignment of patients to treatment randomized and concealed?
  3. Were all patients who entered the trial properly accounted for?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Were the study patients similar to my patients?
  9. Were the measured outcomes clinically relevant?
  10. Were all clinically important outcomes considered?
  11. Are the likely treatment benefits worth the potential harm and costs?
  12. Is there adequate information to be certain that the investigators had access to raw data, performed the analysis independently and had control over the decision to publish?
  13. Is the sponsor's role clearly disclosed?
  14. State the conclusion. Have authors addressed the question posed?
  15. Does the evidence support the conclusion?
  16. Is there any concern that the results are possibly invalid due to interference by the sponsor?
Articles

1. Efficacy and safety of recombinant human activated protein C for severe sepsis; Bernard GR, Vincent JL, Laterre PF, et al: Efficacy and Safety of Recombinant Human Activated Protein C for Severe Sepsis. NEJM 2001; 344(10): 699-709/759-62

2. Is academic medicine for sale?; Angell M: Is Academic Medicine for Sale? NEJM 2000; 342(20): 1516-18

3. Sponsorship, authorship and accountability; Davidoff F, DeAngelis CD, Drazen JM, et al: Sponsorship, Authorship, and Accountability. NEJM 2001; 345(11): 825-27

4. Scietific data from clinical trials;
Polk Jr. HC, Bowden Jr. TA Rikkers LF, et al: Scientific Data from Clinical Trials: Investigators' Responsibilities and Rights World J Surg. 2002; 26: 637-38
 
In addition to these articles, please refer to the Oct. 02 methodological article.
 
Reviews
Clinical Review (Can): Nick Christou - McGill University
Methodological Review: Jeffrey Barkun - McGill Unviersity

October 2002

Topics
1. Clinical Topic: Rectal ca - TME vs. radiation and TME
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized and concealed?
  3. Were all patients who entered the trial properly accounted for?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Were the study patients similar to my patients?
  9. Were the measured outcomes clinically relevant?
  10. Were all clinically important outcomes considered?
  11. Are my surgical skills similar to those of the study surgeons?
  12. State the conclusion. Have the authors addressed the question?
  13. Does the evidence support the conclusion?
Articles

1. Preoperative radiotherapy combined with TME for resectable rectal cancer; Kaiteijn E, Marijnen CAM, Nagtegaal ID, et al: Preoperative Radiotherapy Combined with Total Mesorectal Excision for Resectable Rectal Cancer, NEJM 2001; 345(9): 638-46

2. How to Use an Article Evaluating Surgical Interventions; Urschel JD, Goldsmith CH, Tandan VR, Miller JD; for the Evidence-Based Surgery Working Group.  Users' Guide to Evidence-Based Surgery: How to Use an Article Evaluating Surgical Interventions  CJS 2001; 44(2): 95-100
 
Reviews
Clinical Review (Can): Terry Phang - University of British Columbia
Methodological Review: Carole Richard - University of Montreal

May 2002

Topics
1. Clinical Topic: Transfusion requirements in critical care
2. Methodological Topic: Number Needed to Treat/Confidence Intervals/Equivalence
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusions?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect? Calculate 95% CI around the difference in 30 day mortality rates between groups.
  8. State the estimates upon which the sample size was calculated. In retrospect, were they accurate?
  9. Can the results be applied to my patient care?
  10. Were all clinically important outcomes considered?
  11. Are the likely treatment benefits worth the potential harm and costs?
  12. State the conclusion. Have the authors addressed the question posed?
  13. Does the evidence support the conclusion?
Articles

1. Transfusion requirements in critical care; Hťbert PC, Wells G, Blajchman MA, et al: A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care NEJM 1999; 340(6): 409-417

2. Interpreting study results: confidence intervals; Guyatt G, Jaeschke R, Heddle N, Cook D, Shannon H, Walter S: Basic Statistics for Clinicians: Interpreting Study Results: Confidence Intervals. Can Med Assoc J 1995; 152(2): 169-173
 
Reviews
Clinical Review (Can): John Marshall - University of Toronto
Methodological Review: Carole Richard - University of Montreal

April 2002

Topics
1. Clinical Topic: Recurrent Rectal Ca
2. Methodological Topic: Economic Analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Did the analysis provide a full economic comparison of health care strategies?
  3. Was a broad enough viewpoint adopted?
  4. Were all the relevant clinical strategies compared?
  5. Were the costs and outcomes properly measured and valued?
  6. Was clinical effectiveness established?
  7. Were costs measured accurately?
  8. Were data on costs and outcomes appropriately integrated?
  9. Was appropriate allowance made for uncertainties in the analysis?
  10. What were the incremental costs and outcomes of each strategy?
  11. Do incremental costs and outcomes differ between subgroups?
  12. Could my patients expect similar health outcomes?
  13. State the conclusion. Have the authors addressed the question posed?
  14. Does the evidence support the conclusion?
Articles

1. Cost effectiveness analysis of therapy for locally recurrent rectal cancer; Miller AR, Cantor SB, Peoples GE, et al: Quality of Life and Cost Effectiveness Analysis of Therapy for Locally Recurrent Rectal Cancer. Dis Colon Rectum 2000; 43(12): 1695-1703

2. How to use an article on economic analsysis (a); Drummond MF, Richardson WS, O'Brien BJ, et al, for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature. XIII. How to Use an Article on Economic Analysis. JAMA 1997; 277(19): 1552-1557

3. How to use an article about economic analysis (b); O'Brein BJ, Heyland D, Richardson WS, et al, for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature. XIII. How to Use an Article on Economic Analysis. JAMA 1997; 277(22): 1802-1806
 
Reviews
Clinical Review (Can): Geoffrey Porter - Dalhousie University
Methodological Review: Mark Taylor - University of Manitoba

March 2002

Topics
1. Clinical Topic: Thyroid Cancer
2. Methodological Topic: Decision Analysis
 
Questions
  1. What is the clinical question being addressed
  2. Were all important strategies and outcomes included?
  3. Were all of the relaistic clinical strategies compared?
  4. Were all clinically relevant outcomes considered?
  5. Was an explicit and sensible process used to identify, select and combine the evidence into probabilities?
  6. Were the utilities obtained in an explicit and sensible way from credible sources?
  7. Was the potential impact of any uncertainty in the evidence determined?
  8. Does one strategy result in a clinically important gain for patients?
  9. How strong is the evidence used in the analysis?
  10. Could the uncertainty in the evidence change the results>?
  11. Do the probability estimates fit my patients' clinical features?
  12. Do the utilities reflect how my patients would value the outcomes of the deicsion?
  13. State the conclusion. Have the authors addressed the question posed?
  14. Does the evidence support the conclusion?
Articles

1. Total thyroidectomy vs. thyroid lobectomy in patients with low risk differentiated thyroid cancer; Kebebew E, Duh QY, Clark OH; Total Thyroidectomy or Thyroid Lobectomy in Patients with Low-risk Differentiated Thyroid Cancer: Surgical Decision Analysis of a Controversy Using a mathematical Model. World J. Surg. 2000; 24: 1295-1302

2. How to use an clinical decision analysis (a); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group.  Users' Guides to the Medical Literature.  VII. How to Use a Clinical Decision Analysis.  JAMA 1995; 273(16): 1292-1295

3. How to use a clinical decision analysis (b); Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group.  Users' Guides to the Medical Literature.  VII. How to Use a Clinical Decision Analysis.  JAMA 1995; 273(20): 1610-1613
 
Reviews
Clinical Review (Can): Rick Nason - University of Manitoba
Methodological Review: Carole Richard - University of Montreal

February 2002

Topics
1. Clinical Topic: AAA
2. Methodological Topic: Number Needed to Treat/Confidence Intervals/Equivalence
 
Questions
  1. What is the clinical question being addressed?
  2. What is the study design?
  3. Did the authors appropriately define the "cases"
  4. How were cases diagnosed?
  5. What is the population?
  6. Are the results generalizable to your own population?
  7. What are the strengths of the study?
  8. What are the possible sources of bias?
  9. Did the authors measure the incidence or prevalence of AAA?
  10. State the conclusion. Have the authors addressed the question posed?
  11. Does the evidence support the conclusion?
  12. How may this information be helpful in clinical practice or future research?
Articles

1. Routine ultrasound screening for abdominal aortic aneurysm among 65 - and 75- year old men; Vasquez C, Sakalihasan N, D'Harcour JB and Limet R: Routine Ultrasound Screening for Abdominal Aortic Aneursym among 65- and 75- Year-Old Men in a City of 200,000 Inhabitants. Annals of Vascular Surgery 1998; 12(6): 544-549 (no link available)

2. Frequency in clinical epidemiology-the essentials; Frequency in: Clinical Epidemiology-the essentials (Williams & Wilkins, Ed) Waverly Press Inc. 1982: 75-90 (no link available)
 
Reviews
Clinical Review (Can): Daryl Kucey - University of Toronto
Methodological Review: Andrew Hill - University of Ottawa

January 2002

Topics
1. Clinical Topic: Pulmonary Embolus
2. Methodological Topic: Diagnostic Tests
 
Questions
  1. What is the clinical question being asked?
  2. Is this a question of diagnosis or screening?
  3. Was there an independent, blind comparison to a gold standard test?
  4. Did the patient sample include an appropriate spectrum of patients?
  5. Did the results of the test being evaluated influence the decision to perform the reference standard?
  6. Were the methods for performing the test adequately described?
  7. Were likelihood ratios for the test results presented or data necessary for their calculation included?
  8. Will the reproducibility of the test results and its interpretation be satisfactory in my setting?
  9. Are the results applicable to my patients?
  10. Will the results change my management?
  11. Will patients be better off as a result of the test?
  12. State the conclusion. Have the authors addressed the question posed?
  13. Does the evidence support the conclusion?
Articles

1. Prospective evaluation of dual section helical CT vs. selective angiography in pulomonary embolism detection; Qanadli S, Hajjam ME, Barrť O, et al. Pulmonary Embolism Detection: Prospective Evaluation of Dual-Section Helical CT versus Selective Pulmonary Arteriography in 157 Patients. Radiology 2000; 217(2): 447-455

2. How to use an article about a diagnostic test (a); Jaeschke R, Guyatt G, Sackett DL, for the Evidence-Based Medicine Working Group. User's Guides to the Medical Literature. III How to Use an Article About a Diagnostic Test. JAMA 1994; 271(5): 389-391

3. How to use an article about a diagnostic test (b); Jaeschke R, Guyatt G, Sackett DL, for the Evidence-Based Medicine Working Group. User's Guides to the Medical Literature. III How to Use an Article About a Diagnostic Test. JAMA 1994; 271(9): 703-707
 
Reviews
Clinical Review (Can): John Drover - Queen's Unviersity
Methodological Review: Harry Heteleff - Dalhousie University

December 2001

Topics
1. Clinical Topic: Prophylactic Mastectomy
2. Methodological Topic: Number Needed to Treat/Confidence Intervals/Equivalence
 
Questions
In this session, we will focus on the issue of how to measure treatment. In addition please consider the following issues:
  1. What is the clinical question being addressed?
  2. What is the design of the study?
  3. What are the potential biases in this study?
  4. Would it be possible to perform a randomized controlled trial to address this question? What would be some of the issues that might make it difficult to perform a randomized controlled trial?
  5. Using the unadjusted data in Tables 5 and 6 calculate the following:
    • Relative risk reduction
    • Odds ratio
    • Absolute risk reduction
    • Number needed to treat
For all of the above calculate both the number of breast cancers and the number of deaths.
In doing so, assume that the expected number of deaths were actually observed in a second cohort of woman. Secondly, that n in both groups = 214.
Articles

1. Efficacy of bilateral prohylactic mastecteomy in women with a family history of breast cancer; Hartmann LC, Schaid DJ, Woods JE, et al: Efficacy of Bilateral Prophylactic Mastectomy in women with a Family History of Breast Cancer. NEJM 1999; 340(2): 77-84

2. Assessing the effects of treatment; Jaeschke R, Guyatt G, Shannon H, et al: Assessing the Effects of Treatment: Measures of Association. CMAJ 1995; 152: 351-357
 
Reviews
Clinical Review (Can): Rona Chiefetz - Univesity of British Columbia
Methodological Review: Robin McLeod - University of Toronto

November 2001

Topics
1. Clinical Topic: Incisional Hernia
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusions?
  4. Was there adequate blinding of patients, their clinicians and study personnel?
  5. Were the groups similar at the start of the trial?
  6. Was there adequate standardization of the surgical procedure?
  7. How large and precise was the treatment effect?
  8. Are the procedures adequately described so that they can be used in your own patient care?
  9. Are the surgical techniques that were compared still relevant or have they been supplanted by newer procedures?
  10. Were all clinically important outcomes considered?
  11. Are the likely treatment benefits worth the potential harm and costs?
  12. State the conclusion. Have the authors addressed the question posed?
  13. Does the evidence support the conclusion?
 
Articles

1. Suture vs. mesh repair for incisional hernia; Luijendijk RW, Hop WCJ, Van Den Tol P, et al: A Comparison of Suture Repair with Mesh Repair for Incisional Hernia Repair. NEJM 2000; 343 (6): 392-398

2. Issues in surgical randomized controlled trials; McLeod, RS: Issues in Surgical Randomized Controlled Trials. World J. Surg 1999; 23: 1210-1214
 
Reviews
Clinical Review (Can): John Bohnen - University of Toronto
Methodological Review: Jeffrey Barkun - McGill Unviersity

October 2001

Topics
1. Clinical Topic: Duodenal Ulcers
2. Methodological Topic: Treatment Effectiveness
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusions?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Can the results be applied to my patient care?
  9. Were all clinically important outcomes considered?
  10. Are the likely treatment benefits worth the potential harm and costs?
  11. State the conclusion. Have the authors addressed the question posed?
  12. Does the evidence support the conclusion?
Articles

1. Endoscopic retreatment vs. surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers; Lau JYW, Sung JJY, Lam YH, et al: Endoscopic Retreatment Compared With Surgery In Patients with Recurrent Bleeding After Initial Endoscopic Control of Bleeding Ulcers. NEJM 1999; 340 (10): 751-756

2. How to use an article about therapy or prevention (a); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1993 Dec 1; 270(21): 2598-2601

3. How to use an article about therapy or prevention (b); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1994 Jan 5; 271(1): 59-63
 
Reviews
Clinical Review (Can): Stewart Hamilton - University of Alberta
Methodological Review: Robin McLeod - University of Toronto

May 2001

Topics
1. Clinical Topic: Vascular surgery
2. Methodological Topic: Health Services Research
 
Questions
  1. What is the clinical question being addressed?
  2. Are the outcome measures accurate and comprehensive?
  3. Were the comparison groups similar with respect to important determinants of outcome, other than the one of interest?
  4. Were there clearly identified, sensible comparison groups?
  5. Were residual differences adjusted for in the analysis?
  6. State the conclusion. Have the authors addressed the question posed?
  7. Does the evidence support the conclusion?
Articles

1. Relation of surgical volume to outcome; Khuri SF, Daley J, Henderson W, Hur K, Hossain M, et al: Relation of Surgical Volume to Outcome in Eight Common Operations. Annals of Surgery 1999; 230 (3): 414-432

2. How to use an article reporting variations in the ourcomes of health services; Naylor CD, Guyatt GH, for the Evidence-Based Medicine Working Group: User's Guide to the Medical Literature. X. How to Use an Article Reporting Variations in the Outcomes of Health Services. JAMA 1996; 275 (7): 554-558
 
Reviews
Clinical Review (Can): Marko Simunovic - McMaster University
Methodological Review: Andrew Hill - University of Ottawa

April 2001

Topics
1. Clinical Topic: Pnuemonia in ICU
2. Methodological Topic: Causation/Risk Factors
 
Questions
  1. What is the clinical question being addressed?
  2. Were there clearly identified comparison groups that were similar with respect to important determinants of outcome other than the one of interest?
  3. Were the exposures and outcomes measured in the same way in the groups being compared?
  4. Was follow-up sufficiently long and complete?
  5. Is the temporal relationship correct?
  6. Is there a dose-response gradient?
  7. How strong is the association between exposure and outcome?
  8. How precise is the estimate of the risk?
  9. Are the results applicable to my practice?
  10. What is the magnitude of the risk?
  11. Should I attempt to stop the exposure?
  12. State the conclusion. Have the authors addressed the question posed?
  13. Does the evidence support the conclusion?
Articles

1. Risk factors for ventilator associated pnuemonia in critically ill patietns; Cook DJ, Walker SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, Jaeshke RZ, Brun-Buisson C, for the Canadian Critical Care Trials Group. Incidence of and Risk Factors for Ventilator-Associated Pneumonia in Critically Ill Patients. Annals of Medicine 1998; 129(6): 433-440 (no link available)

2. How to use an article about harm; Mitchell L, Walter S, Lee H, Haines T, Holbrook A, Moyer V, for the Evidence-Based Medicine Working Group. Users' Guides to the Medical Literature. IV. How to Use an Article about Harm. JAMA 1994; 271(20): 1615-1619
 
Reviews
Clinical Review (Can): John Marshall - University of Toronto
Methodological Review: Harry Heteleff - Dalhousie University

March 2001

Topics
1. Clinical Topic: Surgical options for early stage breast cancer
2. Methodological Topic: Quality of Life
 
Questions
  1. What is the clinical question being addressed?
  2. Did the HRQL Instruments work in the way they are supposed to?
  3. Are there important aspects of HRQL that they have been omitted?
  4. If there were trade-offs between quality and quantity of life, or an economic evaluation, have the investigators used the right measures?
  5. What was the magnitude of effect on HRQL?
  6. Will the results help me in caring for my patients?
  7. Did the study design simulate clinical practice?
  8. State the conclusion. Have the authors addressed the question posed?
  9. Does the evidence support the conclusion?
Articles

1. Surgical Options for early stage breast cancer; Pusic A, Thompson TA, Kerrigan CL, Sargeant R, Slezak S, Chang BW, Helzlsouer KJ: Surgical Options for Early-Stage Breast Cancer: Factors Associated with Patient Choice and Postoperative Quality of Life. Plastic and Reconstructive Surgery 1999; 104 (5): 1325-1333 (no link available)

2. How to use an article about health related quality of life; Guyatt GH, Naylor CD, Juniper E, Heyland DK, Jaeschke R, Cook DJ, for the Evidence-Based Medicine Working Group: User's Guide to the Medical Literature. XII. How to Use Articles About Health-Related Quality of Life. JAMA 1997; 277 (15): 1232-1237
 
Reviews
Clinical Review (Can): Steven Latosinsky - University of Manitoba
Methodological Review: Carole Richard - University of Montreal

February 2001

Topics
1. Clinical Topic: Hyperparathyroidism
2. Methodological Topic: Prognosis/Natural History
 
Questions
  1. What is the clinical question being addressed?
  2. Was there a representative and well-defined sample of patients at a similar point in the course of the disease?
  3. Was follow-up sufficiently long and complete?
  4. Were objective and unbiased outcome criteria used?
  5. Was there adjustment for important prognostic factors?
  6. How large is the likelihood of the outcome event(s) in a specified period of time?
  7. How precise are the estimates of likelihood?
  8. Will the results help me in caring for my patients?
  9. Will the results lead directly to selecting or avoiding therapy?
  10. Are the results useful for reassuring or counseling patients?
  11. State the conclusion. Have the authors addressed the question posed?
  12. Does the evidence support the conclusion?
Articles

1. Prospective study of primary hyperparathyroidism; Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP: A 10 - Year Prospective Study of Primary Hyperparathyroidism With or Without Parathyroid Surgery. NEJM 1999; 341: 1249-1255

2. Treatment of hyperparathryoidism; Utiger RD. Editorials: Treatment of Primary Hyperparathyroidism. NEJM 1999; 341: 1301-1302

3. How to use an article about prognosis; Laupacis A, Wells G, Richardson WS, Tugwell P, for The Evidence-Based Working Group: Users' Guides to the Medical Literature. V. How to Use an Article About Prognosis. JAMA 1994; 272: 234-237
 
Reviews
Clinical Review (Can): Noelle Davis - University of British Columbia
Methodological Review: Robin McLeod - University of Toronto

January 2001

Topics
1. Clinical Topic: Virtual colonoscopy
2. Methodological Topic: Diagnostic Tests
 
Questions
  1. What is the clinical question being asked?
  2. Is this a question of diagnosis or screening?
  3. Was there an independent, blind comparison to a gold standard test?
  4. Did the patient sample include an appropriate spectrum of patients?
  5. Did the results of the test being evaluated influence the decision to perform the gold standard test?
  6. Were the methods for performing the test adequately described?
  7. Were likelihood ratios for the test results presented or data necessary for their calculation provided?
  8. Will the reproducibility of the test results be satisfactory in my setting?
  9. Are the results applicable to my patients?
  10. Will the results change my management?
  11. Will patients be better off as a result of the test?
Articles

1. Virtual colonoscopy; Fenlon HM, Nunes DP, Schroy III PC et al: A comparison of Virtual and Conventional Colonoscopy for the Detection of Colorectal Polyps. NEJM 1999; 341: 1496-1503

2. How to use an article about a diagnostic test (a); Jaeschke R, Guyatt GH, Sackett DL: for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. III. How to Use an Article about a Diagnostic Test. A. JAMA 1994 Feb 2; 271(5): 389-391

3. How to use an article about a diagnostic test (b); Jaeschke R, Guyatt GH, Sackett DL: for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. III. How to Use an Article about a Diagnostic Test. B. JAMA 1994 Mar 2; 271(9): 703-707
 
Reviews
Clinical Review (Can): Zane Cohen - University of Toronto
Methodological Review: Mark Taylor - University of Manitoba

December 2000

Topics
1. Clinical Topic: ERCP vs. Lap cholecystectomy
2. Methodological Topic: Number Needed to Treat/Confidence Intervals/Equivalence
 
Questions
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusions?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Can the results be applied to my patient care?
  9. Were all clinically important outcomes considered?
  10. Are the likely treatment benefits worth the potential harm and costs?
  11. State the conclusion. Have the authors addressed the question posed?
  12. Does the evidence support the conclusion?

You may refer to the methodology article distributed Oct. 2000 on "How to assess an article detrmining treatment effectiveness"

Articles

1. ERCP vs. Lap cholecystectomy; Cushieri A, Lezoche E, Morino, M et al: E.A.E.S. Multicentre prospective randomized trial comparing two-stage vs single stage management of patients with gallstone disease and ductal calculi. Surg Endosc (1999) 13: 952-957 (no link available)

2. Interpreting study results: confidence intervals; Guyatt G, Jaeschke R, Heddle N, Cook D, Shannon H, Walter S: Basic Statistics for Clinicians: Interpreting Study Results: Confidence Intervals. Can Med Assoc J (1995) Jan 15; 152 (2): 169-173
 
Reviews
Clinical Review (Can): Roger Keith - University of Sasketchewan
Methodological Review: Jeffrey Barkun - McGill Unviersity

November 2000

Topics
1. Clinical Topic: Lap. vs. conventional hernia repair
2. Methodological Topic: Meta-analysis
 
Questions
  1. What is the clinical question being addressed?
  2. Were the criteria used to select articles for inclusion
  3. Is it unlikely that important relevant studies were missed?
  4. Was the validity of the included studies appraised?
  5. Were assessments of the studies reproducible?
  6. Were the results similar from study to study?
  7. What are the overall results of the overview? How precise were the results?
  8. Were all clinically important outcomes considered?
  9. Are the benefits worth the harms and costs?
  10. State the conclusion. Have the authorsí addressed the question posed? Does the evidence support the conclusion?
Articles

1. Laparosocopic vs. conventional inguinal hernia repairs; Chung RS, Rowland DY: Meta-analyses of randomized controlled trials of laparoscopic vs conventional inguinal hernia repairs. Surg Endosc 1999; 13: 689-694 (no link available)

2. How to use an article on overview; Oxman AD, Cook DJ, Guyatt GH, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. VI. How to Use an Overview. JAMA 1994; 272: 1367-1371
 
Reviews
Clinical Review (Can): Lloyd Smith - University of Toronto
Methodological Review: Robin McLeod - University of Toronto

October 2000

Topics
1. Clinical Topic: Open vs. Lap Nissen
2. Methodological Topic: Treatment Effectiveness
 
Questions
 
  1. What is the clinical question being addressed?
  2. Was the assignment of patients to treatment randomized?
  3. Were all patients who entered the trial properly accounted for and attributed at its conclusions?
  4. Were patients, their clinicians and study personnel "blind" to treatment?
  5. Were the groups similar at the start of the trial?
  6. Aside from the experimental intervention, were the groups treated equally?
  7. How large and precise was the treatment effect?
  8. Can the results be applied to my patient care?
  9. Were all clinically important outcomes considered?
  10. Are the likely treatment benefits worth the potential harm and costs?
  11. State the conclusion. Have the authors addressed the question posed? Does the evidence support the conclusion
Articles

1. Open vs. Lap Nissen; Bais JE, Bartelsman JFWM, et al: Laproscopic or conventional Nissen fundoplication for gastro-oesophageal reflux disease: randomised clinical trial. Lancet 2000; 355: 170-174

2. How to use an article about therapy or prevention (a); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1994 Jan 5; 271(1): 59-63

3. How to use an article about therapy or prevention (b); Guyatt GH, Sackett DL, Cook DJ, for the Evidence Based Medicine Working Group. Usersí Guides to the Medical Literature. II. How to Use an Article about Therapy or Prevention. JAMA 1993 Dec 1; 270(21): 2598-2601
 
Reviews
Clinical Review (Can): Richard Finley - University of British Columbia
Methodological Review: Robin McLeod - University of Toronto
   
   
   
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