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  • Evidence Based Health Care: Delfini Home
    video tutorial on critical appraisal while the video is at a high level there s an living demo on how to do a critical appraisal fast efficiently and effectively Video slide printout and tools are also available at this link To navigate our website See our Quick Picks to selected sections to the left See our Main Menu to the right Beneath our Main Menu you will find our Quick Navigator to some of our key resources Books See Delfini Group Publishing for our books including the highly praised Basics For Evaluating Medical Research Studies A Simplified Approach Best help with evidence based medicine available Martin Gabica MD Chief Medical Officer Healthwise Workshops Critical Appraisal of the Medical Literature for Therapies Selected Topics July 13 14 2016 Portland Oregon Or we come to you click here to learn about other workshop topics What people say about Delfini impressive terrific conference impressive tools already using in real life valuable fun memorable made hard stuff easy to understand helped us change real success improved patient care invaluable thanks for presenting this valuable information in a fun and memorable way I thought the subject was going to be boring and not much use I was very wrong I cannot thank you and Sheri enough I know a couple hundred people who have got to hear your message Best one day educational program I ve experienced in 25 years Delfini evidence reviews are consistently praised as useful rigorous and transparent Delfini average training program scores are 4 8 out of 5 0 gifted facilitators and passionate educators have rarely encountered presenters so well prepared and well versed in their subject matter both are engaging up beat and empowering extremely generous with their knowledge and expertise See all of our Testimonials The Delfini Mission Our

    Original URL path: http://www.delfini.org/ (2016-02-01)
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  • Evidence Based Health Care: Delfini What's New
    of Medical Research Studies Claiming Superiority for Efficacy of Therapies at the Delfini Blog and now our tutorial 04 25 2015 What s new Our new book for Medical Technology Assessment The Medical Technology AssessmentEvidence Based Decision Making Handbook Practical Guidance Advice Strategies Tips and Efficiencies Delfini Group Evidence based Practice Series 04 17 2015 What s new Our new book for Pharmacy Therapeutics Committees The Pharmacy Therapeutics Committee Evidence Based Decision Making Handbook Practical Guidance Advice Strategies Tips and Efficiencies Delfini Group Evidence based Practice Series 04 01 2015 Happy Birthday Delfini Today we turn 13 No foolin 03 09 2015 Biosimilars FDA s New Purple Book at the Delfini Blog and at the DelfiniClick 03 02 2015 Genomic Medicine Leaps Forward More Drugs Targeting More Cancers at the Delfini Blog and at the DelfiniClick 02 27 2015 ISPOR International Society For Pharmacoeconomics and Outcomes Research 20th Annual International Meeting Clinical Outcomes Studies Poster Presentation on May 19 2015 Strite S Stuart ME Beckman V Öhrling K Comparing the efficacy of denosumab versus zoledronic acid ZA for prevention of skeletal related events SREs a critical appraisal of three pivotal trials From Our DelfiniGram February 2015 02 01 2015 Progression Free Survival PFS in Oncology Trials at the Delfini Blog and at the DelfiniClick 01 30 2015 BMJ s Minerva featured as its top story this week for its inside back cover the paper we wrote with DynaMed Editorial colleagues Journal of the Royal Society of Medicine Evolution of evidence based medicine to detect evidence mutations BMJ 2015 350 h405 http www bmj com content 350 bmj h405 You can access our paper here at What s New See entry immediately below for 01 07 15 01 07 2015 Paper published with DynaMed editorial board colleagues in the Journal of the Royal Society of Medicine Alper BS Fedorowicz Z Strite SA Stuart ME Shaughnessy AF Evolution of evidence based medicine to detect evidence mutations J R Soc Med 2015 Jan 108 1 8 10 doi 10 1177 0141076814555936 PubMed PMID 25572989 If you cannot retrieve the article directly you can access the accepted paper here 01 05 2015 Network Meta analyses More Complex Than Traditional Meta analyses at the Delfini Blog and at the DelfiniClick 12 08 2014 Sounding the Alarm Again in Oncology at the Delfini Blog and at the DelfiniClick 10 29 2014 Comparative Effectiveness Research CER Big Data Causality at the Delfini Blog and at the DelfiniClick From Our DelfiniGram October 2014 10 13 2014 Cochrane Risk Of Bias Tool For Non Randomized Studies at the DelfiniClick 10 06 2014 Comparison of Risk of Bias Ratings in Clinical Trials Journal Publications Versus Clinical Study Reports at the DelfiniClick 08 20 2014 Clinical Guidelines and Elderly Patients Proceed with Caution at the DelfiniClick 06 18 2014 Comparative Study Designs Claiming Superiority Equivalence and Non inferiority A Few Considerations Practical Approaches available at the DelfiniClick 06 16 2014 We have a short article for industry colleagues now published in

    Original URL path: http://www.delfini.org/delfiniNew.htm (2016-02-01)
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  • Evidence Based Health Care: Critical Appraisal Facts
    John Ioannidis charges that as much as 90 percent of the published medical information that doctors rely on is flawed We think this is just the tip of the iceberg Read Delfini Letter and Commentary on Lies Damned Lies and Medical Science by David H Freedman The Atlantic November 2010 Strite Freedman In one survey of 60 352 studies a meager 7 passed criteria of high quality methods and clinical relevancy McKibbon and fewer than 5 passed a validity screening for an evidence based journal Glasziou Fact 4 There is nowhere to turn for trustable healthcare information FDA approval is not sufficient for establishing scientific validity and usefulness We know of no fully trustable healthcare information sources and sources that claim to be evidence based frequently are not Some of the best and most trusted sources have frequently failed our critical appraisal audits Most secondary sources are based on invalid studies or studies that do not have clinically meaningful outcomes This includes reviews meta analyses performance measures clinical recommendations pharmacoeconomic studies disease management protocols and more Clinical guidelines vary in quality and the majority may be invalid including many from professional societies Fact 5 Possessing skills in critical appraisal matters Bias in studies tends to favor the intervention under investigation Certain kinds of bias have been shown to distort research results up to a relative 50 percent or more for each flaw References for the evidence on the distorting effects of are available upon request to delfini at delfini org Furthermore there are a lot of other problems that possessing critical appraisal skills are likely to solve here are just a few examples Most physicians rely on abstracts which are frequently inaccurate One study found that 18 68 percent of abstracts in 6 top tier medical journals contained information not verifiable in the body of the article Pitkin One study concluded that there may be considerable bias in p values reported in abstracts Gøtzsche Physicians and others who understand critical appraisal know it cannot be determined whether a study is valid by reading the abstract Many physicians rely on information that should be treated as hypothesis generating only Physicians who understand critical appraisal know how to avoid being mislead by this Author s conclusions are opinions not evidence and authors are often biased even with the best of intentions Authors frequently use misleading terms or draw misleading conclusions Physicians and others who lack critical appraisal skills often get had by this whereas critical appraisal knowledge can frequently defend against these problems Physicians and others who do not understand issues with findings that are not statistically significant frequently mistakenly interpret these findings as meaning there is no meaningful difference between the groups Those with critical appraisal skills understand how to use confidence intervals to avoid these erroneous interpretations Solutions Attaining critical appraisal skills need not be hard or time consuming individuals can easily acquire the basic skills and without learning much about statistics Skills can be easily acquired in a short

    Original URL path: http://www.delfini.org/delfiniFactsCriticalAppraisal.htm (2016-02-01)
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  • Evidence Based Health Care: Delfini Services
    or physicians and others involved in systematic reviews Workshops on The Evidence based Organization Clinical improvement projects training facilitation Clinical guideline development methods training facilitation Clinician patient communications training see below for more details See Our Seminars Page See a sampler of our work and free help to you almost live See our freely available video tutorial on critical appraisal while the video is at a high level there s an living demo on how to do a critical appraisal fast efficiently and effectively Video slide printout and tools are also available at this link Tailored Training for Specific Groups Pharmacy Therapeutics Committees Medical Technology Assessment Committees Quality Improvement Councils Quality Improvement Teams Clinical Guideline Pathway Development Teams Journal Clubs Other EBM working groups Specific healthcare professionals e g medical leaders physicians clinical pharmacists nurses other allied health care professionals etc Industry Other healthcare groups e g patient decision support companies How We Approach Training Leadership Culture Staff Needs and skills assessments Systems and process review and solutions Training methods materials communications training designed to meet the needs of the target group Communications Training Program scores averaging 5 0 out of 5 0 Creating and implementing decision support information action and decision aids Communicating with colleagues clients and patients Physician patient communications including special topics Evidence based Committee Help We can assist you in creating or improving the process and evidence review skills of your pharmacy and therapeutics P T and medical technology assessment MTA committees or any evidence based quality improvement QI group such as a guideline or pathway group or even a journal club How to develop organize and manage effective evidence based committees quality teams journal clubs and other evidence based working groups Quality Improvement Project Help We can help you or teach you to conduct a

    Original URL path: http://www.delfini.org/index_Services.htm (2016-02-01)
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  • Evidence Based Healthcare Training Program
    training facilitation Clinical guideline development methods training facilitation Clinician patient communications Other Services include evidence reviews committee help P T medical technology assessment quality improvement teams etc clinical guideliines evidence based quality improvement project facilitation and more Advanced Seminar Testimonial Two thumbs up for Delfini The recent EBM refresher and advanced EBM training they provided to over 40 McKesson content development clinicians received great reviews from our whole team The refresher reinforced the expertise we have developed in applying the principles of critical appraisal to our clinical content development since we first started working with Delfini four years ago Sheri and Mike s ability to explain complex concepts in an easy to understand and conversational manner produced multiple aha moments for our team Warm thoughts and wishes Kate Kate Flanagan Helmes Director Clinical Development InterQual Products Also we have a book available on critical appraisal of clinical trials as well as an entire evidence based practice series Basics For Evaluating Medical Research Studies A Simplified Approach And Why Your Patients Need You To Know This Delfini Group Evidence based Practice Series Short How to Guide Book Best help with evidence based medicine available Marty Gabica MD Chief Medical Officer Healthwise This book is about how to evaluate the reliability and clinical usefulness of clinical trials Written for physicians and other health care professionals this book is written in easy to understand terms that even the layperson can understand and put to use N ow available for purchase About Portland Oregon And some fun things about Portland http www uniquely portland oregon com Time Magazine Portland Travel Guide Public Transportation including Airport to Downtown About us Delfini is a public service entrepreneurship founded to help solve the little known societal problem of medical misinformation which frequently results from lack of awareness

    Original URL path: http://www.delfini.org/page_Delfini_Seminars.htm (2016-02-01)
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  • Delfini Updates & Contacts
    below Not getting our bimonthly DelfiniGrams Sign up required Email Address Enter the letters shown above Email Newsletter by VerticalResponse Contact Us You can reach Mike and Sheri at Like Us on Facebook to the right or follow us on Twitter We usually send one update every 2 3 weeks Regularly check our websites or get on our e mailing list What s New at www delfini org for updates about additions to our website Delfini Blog at delfini org blog for the above information regular entries of interesting information we find to share with you many of which will not be on our main website Like Us on Facebook Read Our Blog Menu Use of our website implies agreement to our Notices Citations for references available upon request Home What s New Blog Seminars Services Delfini Group Publishing Resources Sample Projects Notices About Us Our Work Testimonials Other Site Search Contact Info Updates Quick Navigator to Selected Resources Tools Educational Library The Healthcare Information Problem Tutorials DelfiniClick commentaries On the Same Page patient decision support Evidence Messaging Scripts Delfini Publications Medical Leader Interviews Glossary Recommended Reading Recommended Web Links Delfini Critical Appraisal Flier Get DelfiniGram Updates Basics For Evaluating

    Original URL path: http://www.delfini.org/index_ContactUs.htm (2016-02-01)
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  • Evidence Based Health Care: Delfini Tool Library
    for working with secondary studies sources including audit advice PDF WORD CRITICAL APPRAISAL Secondary Studies Short Tool 1 Pager Pearls Basics of Evaluating Secondary Studies including meta analyses Version 05 23 2014 Novice Intermediate teaching tool self study guide reminder tool PDF WORD CRITICAL APPRAISAL Secondary Studies Comprehensive Tool 10 Pager Systematic Review Tool Version 01 29 2013 Principal tool for appraising secondary studies teaching tool self study guide PDF WORD CRITICAL APPRAISAL Secondary Sources Short Tool 1 Pager Pearls Basics of Evaluating Secondary Sources eg clinical guidelines pathways clinical recommendations disease management protocols Version 09 07 2010 Novice Intermediate teaching tool self study guide reminder tool PDF WORD CRITICAL APPRAISAL Secondary Sources Comprehensive Tool 10 Pager QI Project Appraisal Tool Secondary Sources reference primary and secondary studies e g clinical guidelines disease management protocols pathways etc Version 04 11 2013 Principal tool for appraising secondary sources teaching tool self study guide PDF WORD CRITICAL APPRAISAL Economic Studies Comprehensive Tool 2 Pager Healthcare Economic Study Review Tool Version 01 29 2013 Principal tool for appraising any economic studies such as cost effectiveness analyses and pharmacoeconomic studies teaching tool self study guide PDF WORD 1 Pager QALYs Version 10 30 2012 Key Points about QALYs PDF WORD CONCLUDING SUMMARIZING 1 Pager Grading Version 07 01 2013 Short advice on evidence grading PDF WORD Grading Wording Conclusions and Results Table Tool Version 04 13 2015 Principal tool for advice on grading and wording results table tool is a cut and paste utility Also information on systems GRADE and AHRQ EHCP PDF WORD Ideal Study Parameters Version 01 30 2013 Preparation for scientific review PDF WORD 1 Pager Evidence Synthesis Overview Version 08 21 2014 Short advice on creating an evidence summary PDF WORD Evidence Synthesis Tool Version 01 30 2013 Tips for combining results from multiple studies PDF WORD The Delfini Decision support Semaphore Example MRI for Women at High Risk of Breast Cancer Version 03 01 2011 Multiple examples Example of a way to present highly complex evidence based information and other considerations PDF WORD for MRI only PDF WORD for sampler including MRI Qualitative Systematic Review Template Master document for assembling a scientific review and report generation Available only through Delfini Programs DOCUMENTATION Primary Studies Study Summary Critique For online documentation for project work WORD Mini online application version For online documentation for project work WORD Quick Appraisal Topic Report Form Also contains a short list of some of our favored sources Version 01 30 2013 Another mini It s good to have various formats to report evidence findings depending on needs This one is a shorty for when your time is limited and you need to keep the report brief Quick process steps included WORD Search Documentation Version 01 30 2013 For online documentation for project work WORD PDF Critical Appraisal Primers White Papers Evidence Essentials Critical Appraisal Online Tutorial A brief and hopefully fun online tutorial on the basics of critical appraisal of therapeutic interventions The emphasis is

    Original URL path: http://www.delfini.org/delfiniTools.htm (2016-02-01)
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  • Evidence Based Health Care: Critical Appraisal Tutorial
    is a short summary of our simplified approach to critically appraising a randomized superiority clinical trial Our focus is on internal validity which means closeness to truth in the context of the study External validity is about the likelihood of reaching truth outside of the study context and requires judgment about issues such as fit with individuals or populations in circumstances other than those in the trial You can review and download a wealth of freely available information at our website at www delfini org including checklists and tools at http www delfini org delfiniTools htm which can provide you with much greater information Most relevant to this blog is our short critical appraisal checklist which you can download here http www delfini org Delfini Tool StudyValidity Short pdf Also you can view a video very high level here and down load the accompanying slides here xxx The Big Questions In brief your overarching questions are these Is reading this study worth my time If the results are true would they change my practice Do they apply to my situation What is the likely impact to my patients Can anything explain the results other than cause and effect Evaluate the potential for results being distorted by bias anything other than chance leading away from the truth or random chance effects Is there any difference between groups other than what is being studied This is automatically a bias If the study appears to be valid but attrition is high sometimes it is worth asking what conditions would need to be present for attrition to distort the results Attrition does not always distort results but may obscure a true difference due to the reduction in sample size Evaluating Bias There are four stages of a clinical trial and you should ask several key questions when evaluating bias in each of the 4 stages Subject Selection Treatment Assignment Evaluation of Selection Bias Important considerations include how were subjects selected for study were there enough subjects how were they assigned to their study groups and were the groups balanced in terms of prognostic variables Your critical appraisal to do list includes a Checking to see if the randomization sequence was generated in an acceptable manner Minimization may be an acceptable alternative b Determining if the investigators adequately concealed the allocation of subjects to each study group Meaning is the method for assigning treatment hidden so that an investigator cannot manipulate the assignment of a subject to a selected study group c Examining the table of baseline characteristics to determine whether randomization was likely to have been successful i e that the groups are balanced in terms of important prognostic variables e g clinical and demographic variables The Intervention Context Evaluation of Performance Bias What is being studied and what is it being compared to Was the intervention likely to have been executed successfully Was blinding likely to have been successful Was duration reasonable for treatment as well as for follow up Was adherence reasonable What else happened to study subjects in the course of the study such as use of co interventions Were there any differences in how subjects in the groups were treated Your to do list includes evaluating a Adequacy of blinding of subjects and all working with subjects and their data including likely success of blinding b Subjects adherence to treatment c Inter group differences in treatment or care except for the intervention s being studied Data Collection Loss of Data Evaluation of Attrition Bias What information was collected and how was it collected What data are missing and is it likely that missing data could meaningfully distort the study results Your to do list includes evaluating a Measurement methods e g mechanisms tools instruments means of administration personnel issues etc b Classification and quantification of missing data in each group e g discontinuations due to ADEs unrelated deaths protocol violations loss to follow up etc c Whether missing data are likely to distort the reported results This is the area that the evidence on the distorting risk of bias provides the least help And so again often it is worthwhile asking What conditions would need to be present for attrition to distort the results Results Assessing The Differences In The Outcomes Of The Study Groups Evaluating Assessment Bias Were outcome measures reasonable pre specified and analyzed appropriately Was reporting selective How was safety assessed Remember that models are not truth Your to do list includes evaluating a Whether assessors were blinded b How the effect size was calculated e g absolute risk reduction relative risk etc You especially want to know benefit or risk with and without treatment c Were confidence intervals included You can calculate these yourself online if you wish See our web links at our website for suggestions d For dichotomous variables was a proper intention to treat ITT analysis conducted with a reasonable choice for imputing values for missing data e For time to event trials were censoring rules unbiased Were the number of censored subjects reported After you have evaluated a study for bias and chance and have determined that the study is valid the study results should be evaluated for clinical meaningfulness e g the amount of clinical benefit and the potential for harm Clinical outcomes include morbidity mortality symptom relief physical mental and emotional functioning and quality of life or any surrogate outcomes that have been demonstrated in valid studies to affect a clinical outcome Final Comment It is not difficult to learn how to critically appraise a clinical trial Health care providers owe it to their patients to gain these skills Health care professionals cannot rely on abstracts and authors conclusions they must assess studies first for validity and second for clinical usefulness Authors are often biased even with the best of intentions Remember that authors conclusions are opinions not evidence Authors frequently use misleading terms or draw misleading conclusions Physicians and others who lack critical appraisal skills are often mislead by

    Original URL path: http://www.delfini.org/page_Good_EBM_Tips.htm (2016-02-01)
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