PSY 433 Lecture Notes - Lecture 10: Confidence Interval, Systematic Review, Psy
29 Jul 2020
Department
Course
Professor
Psychopharmacology
1
PSY 433 Psychopharmacology
Lecture 10
Evidence-based medicine
Evidence-based medicine (MBE) aims to integrateindividual clinical mastery with the best data or
facts (evidence) available when making a decision before the individual patient (Sackett et al.
1997). To this end, a systematic and critical review of the available evidence is carried out,which
is classified according to its quality. If the question is to decide about a treatment, the quality of
the evidence will allow to conclude with greater or lesser force (degree of recommendation) about
the goodness, harm or neutrality of such treatment. According to the MBE Centre in Oxford, the
highest level of evidence is that obtained from randomized clinical trials (ACEs) with
homogeneous results or a single ECA with a narrow confidence interval. Average quality is
obtained fromlow-quality ECA parti r (e.g., those in which there were many follow-up losses, or
the evaluation of the effect was not done blindly), or from high-quality non-randomized controlled
studies. Low-quality evidence from retrospective and case series
studies(www.cebm.net)isconsidered. The highest degree of recommendation for a treatment
(grade A) is obtained from high-quality randomized clinical trials. If the evidencia is contradictory,
or only expert opinions are available, the lowest degree of recommendation (grade D) is obtained.
In the absence of other treatment the clinician may inform the patient of existing doubts about the
effectiveness/secundari effectsof the treatment and leave partly at the patient's discretion whether
or not to follow the treatment.
Two concepts of interest are the number required to treat (NNT) and the number needed to harm
(NNP). Most treatments do not get the desired response in all patients to which they are applied.
A clear example is the treatmentof some cancers. Depending on the type of cancer and treatment,
a variable number of people survive, while another dies. In the
for THE specific drugs for the EA, only one to three people in ten experience clinically relevant
cognitive improvement, and the same goes for the rate of side effects (NNH) (Spector et al., 2003).
The side effects of TNF in EA are very limited, while NNT is similar tothat of the drugs in terms
ofcognitive stimulation, and superior in terms of behavioral improvement (Spector et al., 2003;
Onder et al., Raglio et al., 2008).
Document Summary
Evidence-based medicine (mbe) aims to integrateindividual clinical mastery with the best data or facts (evidence) available when making a decision before the individual patient (sackett et al. To this end, a systematic and critical review of the available evidence is carried out,which is classified according to its quality. If the question is to decide about a treatment, the quality of the evidence will allow to conclude with greater or lesser force (degree of recommendation) about the goodness, harm or neutrality of such treatment. According to the mbe centre in oxford, the highest level of evidence is that obtained from randomized clinical trials (aces) with homogeneous results or a single eca with a narrow confidence interval. Average quality is obtained fromlow-quality eca parti r (e. g. , those in which there were many follow-up losses, or the evaluation of the effect was not done blindly), or from high-quality non-randomized controlled studies. Low-quality evidence from retrospective and case series studies(www. cebm. net)isconsidered.
