Chapter 14: Translating Evidence into Practice

Introduction Putting evidence into practice is perhaps the most challenging and important job facing us whether we are clinicians trying to improve the quality of medical care, public health practitioners trying to improve population health, or health researchers using evidence to design the next investigation. Regardless of how we use research evidence, there are a […]

Chapter 13: A Guide to the Guidelines

Introduction Most practitioners encounter evidence in their daily practice through the use of guidelines or recommendations. Evidence-based guidelines or evidence-based recommendations attempt to synthesize the evidence in order to provide a wide range of recommendations for making decisions. Recommendations for clinical practice are not new; they are as old as the teaching of the health […]

Chapter 12: Decision and Cost-Effectiveness Analysis: M.A.A.R.I.E. Framework—Results, Interpretation, and Extrapolation

Introduction The results component of the M.A.A.R.I.E. framework for decision-making investigations asks us to address the issues of estimation, inference, and adjustment. The aim of estimation is to provide the best possible estimation of the strength of the relationship, that is a measure of the magnitude of the advantage of the best option compared to […]

Chapter 11: Decision and Cost-Effectiveness Analysis: M.A.A.R.I.E. Framework—Method, Assignment, and Assessment

Introduction Decision making in health care and public health has traditionally relied on subjective judgments, expert opinions, and nonquantitative decision making. Today, we increasingly rely on quantitative methods. Potential interventions, from prevention to palliation, are subjected to measurements of outcome that take into account the desirable outcomes (benefits), the undesirable outcomes (harms), and the financial […]

Chapter 10: Screening—Prediction and Decision Rules

Introduction Screening for asymptomatic disease as well as prediction and decision rules are two increasingly important applications of the principle of testing that we examined in Chapters 8 and 9. In this chapter, we will take a look at each of these applications of testing principles. Screening ([1]–[3]) Criteria for Successful Screening Screening is a […]

Chapter 9: Testing a Test—M.A.A.R.I.E. Framework: Results, Interpretation, and Extrapolation

Results ([1],[2]) The results component of the M.A.A.R.I.E. framework for Testing a Test asks about the performance of the index test compared with the reference standard, that is, gold standard test, or definitive test. The results component presents quantitative estimates of the information provided by the index test compared with the perfectly performing reference standard. […]

Chapter 8: Testing a Test—M.A.A.R.I.E. Framework: Method, Assignment, and Assessment

Introduction Testing a Test is about how we use evidence to make decisions. We will begin by using the M.A.A.R.I.E. framework to better understand research articles on tests. That is, we will look at the methods, assignment, assessment, results, interpretation, and extrapolation issues, and see how they apply to evaluation of a test. We will […]

Chapter 7: Meta-analysis

Introduction Thus far, we have examined the basic types of investigations in the health research literature that are designed to compare study and control groups. These investigations often provide consistent results. At times, however, studies published in the health research literature seem to conflict with one another, making it difficult to provide definitive answers to […]

Chapter 6: Safety

Introduction Randomized controlled trials are the gold standard for efficacy so we might ask the question: What is the gold standard for safety? Unfortunately, the answer is not so easy since there is no one type of study that can provide us with all the evidence we need. We might think of the gold standard […]

Chapter 5: Observational Studies

Introduction Randomized controlled trials are the gold standard for efficacy, but they are not the gold standard for effectiveness or safety. In addition, randomized controlled trials may not be feasible or ethical. They are nearly always very expensive and time consuming. Therefore, there is a great need for other types of analytic studies to complement […]