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Paeds Vivasprofessional-practice-and-evidence

Paeds Vivas · professional-practice-and-evidence

Evidence-based medicine and critical appraisal — branching viva

Viva on evidence-based medicine and the critical appraisal of a paediatric study.

branching clinical structured oral2 min readVerification in progress

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
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Study tools

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Journal club: you are given a randomised controlled trial claiming a new therapy halves the risk of a serious complication in children; the abstract reports a 50 percent relative risk reduction, a p-value of 0.04, and a confidence interval whose lower bound crosses unity in some subgroups.

Opening (candidate)

I would treat this as a structured critical appraisal rather than a result handover. First I would frame the question in PICO terms, then judge the internal validity with RoB 2 before reading the results, then extract the absolute effect and its confidence interval, and finally assess applicability to the patient and rate the certainty with GRADE. [2] [7]

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You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship library.

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References7ShowHide
  1. [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. [2]Richardson WS, Wilson MC, Nishikawa J, Hayward RS The well-built clinical question: a key to evidence-based decisions ACP J Club, 1995.PMID 7582737
  3. [3]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
  4. [4]Balshem H, Helfand M, Schünemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence J Clin Epidemiol, 2011.PMID 21208779
  5. [5]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
  6. [6]Greenhalgh T How to read a paper. Statistics for the non-statistician. II: Significant relations and their pitfalls BMJ, 1997.PMID 9277611
  7. [7]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
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