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?

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?

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?

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?

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?

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?

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?

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?

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

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?

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

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?

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?

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? 

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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.

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?

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?

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?

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?

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?

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?

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.  

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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 posed? Does the evidence support the conclusion?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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

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?

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?

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?

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?

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?

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?

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?

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"

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 authors’ addressed the question posed? Does the evidence support the conclusion?

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