Diagnosis General Guidelines: Use this to file to prepare your EBP Rounds presentation if your clinical question is about DIAGNOSIS EBP rounds is time limited, so try to set up your presentation to maximize the opportunity for group discussion The case is not to be morning report style: give just enough information to define the clinical problem at hand The background discussion does not need to be a comprehensive review; again, go into just enough detail to understand the rationale for the study you about to discuss. Feel free to include more or less than is on this template. This is meant to help you, not to dictate what you do. Consider individualizing your group’s presentation by changing the background, adding humor, make it fun! Look in the notes section below each frame; there are informational links that you can use to learn as you go.

Here is a timeline to work with as your group develops EBP rounds

Team X Resident: Interns: Studs: EBP Rounds place date here brief statement about case: xx yo man with hematuria and pulmonary hemorrhage Team X Resident: Interns: Studs:

Brief description of case This should not be a morning report style presentation. You just should present enough information to frame the clinical question.

What is your Clinical Question? Patient: Intervention: Comparison: Outcome: Go here http://www.cebm.utoronto.ca/practise/formulate/ to learn more about how to develop PICO questions and how they help you learn about your patients.

Literature Search How did you find your article? In what way does this represent the “Best Evidence”

Paste copy of title page from article in this slide

Primary Hypothesis or Goal of the Study: What were the investigators tying to test/discover (what was their PICO question going into the study)

Who were the patients in the study? Inclusion Criteria: How did they choose patients in whom to test the test.

Who were the patients in the study? Exclusion Criteria:

Reference (Gold) Standard What was the reference standard that the diagnostic test of interest was compared with (the "Gold Standard")? Is this a reasonable gold standard for comparison?

How was the test of interest actually compared to the Gold Standard? Did interpreters assess the comparison independently? Were they blinded? Was the gold standard valid (in your opinion)? What was the reference standard that the diagnostic test of interest was compared with (the "Gold Standard")? Why is this important? Go here to learn more: http://www.cche.net/usersguides/diagnosis.asp#I1

Spectrum of Patients Did the patient sample include an appropriate spectrum of patients to whom the diagnostic test will be applied in clinical practice? Did they include those with a mild form of the disease? Did they include those with different but potentially confused disorders? Why is this important? Learn here: http://www.cche.net/usersguides/diagnosis.asp#I2

Bias? Did the results of the test being evaluated influence the decision to perform the reference standard? Is there verification bias (also called workup bias)? Why is this important? Learn here: http://www.cche.net/usersguides/diagnosis.asp#I3

Test Procedure Were the methods for performing the test described in sufficient detail to permit replication? This is just a reality test; if the test is not available, then it is not very useful.

Test Precision Will the reproducibility of the test result (precision) and its interpretation be satisfactory in my setting? Is the test reagent-dependent, variable amongst laboratories, or technician-dependent? Is there inter-observer agreement?

Test Performance Sensitivity Specificity Likelihood Ratio (positive test) Likelihood Ratio (negative test) Post-test probability (positive test) Post-test probability (negative test) Your article may or may not specifically report these outcomes, but you can easily derive them from the data. Go here http://www.medcalc.com/bayes.html to help you calculate sensitivity, specificity, and likelihood ratios. What is a likelihood ratio and how do I use them? Go here: http://www.cche.net/usersguides/diagnosis.asp#II1

Methodological Strengths/Weaknesses Summarize your findings from the previous analysis.

Clinical Bottom Line Given the study results and the methodological limitations, what is the clinical bottom line of the paper? What (if anything) did you learn from it?

What does this mean for this patient? Will test results change management? Will the results move you past a test or a treatment threshold? Remember, your patients pre-test probability was probably not the same as the prevalence of the condition in the study population. This means that your post-test probability won’t be the same, either. Learn how to calculate your patient’s post-test probability here: http://www.cche.net/usersguides/diagnosis.asp#II1 Learn about application of diagnostic tests and test/treatment thresholds at http://www.cche.net/usersguides/diagnosis.asp#III3

How will this evidence effect your medical decision making and the use of this diagnostic test in the future?