Evaluating the Evidence
Step 3: How can I apply the results to patient care?
Were the study patients similar to my population of interest?
Does your population match the study inclusion criteria?
If not, are there compelling reasons why the results should not apply to your population?
Were all clinically important outcomes considered?
What were the primary and secondary endpoints studied?
Were surrogate endpoints used?
Are the likely treatment benefits worth the potential harm and costs?
What is the number needed to treat (NNT) to prevent one adverse outcome or produce one positive outcome?
Is the reduction of clinical endpoints worth the increase of cost and risk of harm?
It appears from our brief analysis that this article meets the criteria for validity. To complete the analysis you would need to review the results and determine if they are applicable to Pauline.
Our patient is a 73 year old female with heart failure and a left ejection fraction of 40%. She has no other remarkable past medical history and is living on her own. She meets the inclusion criteria for this study.
The results show that irbesartan may not be effective for our patient. There are also drug interactions to consider. The next step is to talk with the patient.
Take a moment to reflect on how well you were able to conduct the steps in the EBM Process.
Did you ask a relevant, well focused question? Do you have fast and reliable access to the necessary resources? Do you know how to use them efficiently? Did you find a pre-appraised article? If not, was it difficult to critically evaluate the article?
Guyatt, G. Rennie, D. Meade, MO, Cook, DJ. Users' Guide to Medical Literature: A Manual for Evidence-Based Clinical Practice, 2nd Edition 2008.
Note: For validity criteria for other types of studies, see the following
supplements: Diagnosis | Prognosis | Etiology/Harm | Systematic Review
Revised July 2010