Paeds Cases · professional-practice-and-evidence
Appraising a trial for a shared decision — OSCE
OSCE on appraising a randomised trial and applying its evidence to a shared decision with a family.
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Target exams
MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
Parents of a 4-year-old with a chronic illness are deciding whether to start a daily preventive therapy; they have read online that it 'reduces the risk of a serious complication by 50%'; you have a randomised trial in adults reporting that figure, a p-value of 0.04, and a confidence interval whose lower bound crosses unity in children.
Station brief (8–10 minutes)
Help the parents decide whether to start the preventive therapy by appraising the trial honestly and applying it to their child. Address the online '50 percent' figure, the trial's validity, the magnitude and precision of the effect, and its applicability to a four-year-old. Do not invent jurisdiction-specific thresholds or specific survival statistics. [1]
References6ShowHide
- [1]Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS Evidence based medicine: what it is and what it isn't BMJ, 1996.PMID 8555924
- [2]Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials BMJ, 2019.PMID 31462531
- [3]Balshem H, Helfand M, Schünemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence J Clin Epidemiol, 2011.PMID 21208779
- [4]Andrews J, Guyatt G, Oxman AD, et al. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations J Clin Epidemiol, 2013.PMID 23312392
- [5]Greenhalgh T How to read a paper. Statistics for the non-statistician. II: Significant relations and their pitfalls BMJ, 1997.PMID 9277611
- [6]Murad MH, Montori VM, Ioannidis JP, et al. How to read a systematic review and meta-analysis and apply the results to patient care: users' guides to the medical literature JAMA, 2014.PMID 25005654