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Tools & Educational Materials by Delfini

Basics For Evaluating Medical Research Studies:
A Simplified Approach

And Why Your Patients Need You To Know This 

Delfini Group Evidence-based Practice Series
Short How-to Guide Book
...................................................

Delfini Group Publishing

"Best help with evidence-based medicine available."
Marty Gabica, MD, Chief Medical Officer, Healthwise

This book is about how to evaluate the reliability and clinical usefulness of clinical trials. Written for physicians and other health care professionals, this book is written in easy-to-understand terms that even the layperson can understand and put to use. Now available for purchase.

Other tools and educational materials, created by Delfini, to help you perform a variety of tasks including critical appraisal of the medical literature and clinical quality improvements, are freely available below.

Our site makes available other resources as well from the work of others and other work we have done including clinical guidelines, systematic reviews, evidence-based commentaries, case studies and more. See Resources.

Favorite Tool Marks our favorites.

Terms of Use
In downloading or reviewing any of these tools or revewing any the information conveyed in this website which represents our original work, you implicitly agree that you have read our Notices and that you will not use these tools for any commercial purpose outside of delivering usual patient care such as would be provided by a health care system or individual clinician or by an EBM work group, without our permission, plus that you will seek our permission to create any derivative work or for any work utilizing any part of these tools in publication. You also agree that you will abide by the spirit of this intended agreement, and what it is attempting to effect, regardless of its specific wording. Lastly, you agree that you will convey these stipulations to any to whom you provide copies of our work.

Because we are continually refining our tools, we recommend that you download tools just-in-time to ensure you are getting our most current version.

Favorite ToolPossibly Our Most Important Reading

Delfini Fact Sheet: Quality of Care, Quality of Science & Importance of Critical Appraisal Skills
Why we are doing this work; why critical appraisal matters...

Short versions: Delfini Flier & Critical Appraisal Matters: Quick Facts 1-pager Version 01/29/2013

Overview: Framework for Evidence-based Critical Appraisal & Decision-making
1-pager: High-level outline of the "5 A"s framework for EBM and comprehensive considerations
[PDF][WORD]
Version 08/02/2011

Overview: Framework for Evidence-based Critical Appraisal for Clinical Improvement Work
1-pager: Outline of the hallmarks of EBM, the 10-phases of evidence-based clinical QI, "5 A"s of evidence-based practice, critical appraisal steps and key considerations
[PDF][WORD]
Version 08/14/2012

Critical Appraisal Online Tutorial
A brief (and hopefully fun) online tutorial on the basics of critical appraisal of therapeutic interventions. The emphasis is on evaluating efficacy claims of primary studies using superiority designs
.

Searching, Sources & Terms Utility Tools
  • EBM Glossary Online
  • Searching the Medical Literature Tool [WORD] Version 06/23/2014
    • Delfini Favorite Sources [PDF] Version 08/01/2013
  • See also tools for Documentation
  • Others available at Delfini Web Links

Critical Appraisal Tools

Also see Critical Appraisal Online Tutorial: A brief (and hopefully fun) online tutorial on the basics of critical appraisal of therapeutic interventions. The emphasis is on evaluating efficacy claims of primary studies using superiority designs.

Topic Item User Info Get

CRITICAL APPRAISAL
Primary Studies
: Short Tools

Efficacy of therapies in superiority trials; some with notes and considerations for other circumstances

 

1-Pager
Pearls: Basics of Evaluating Evidence in Superiority Trials for Therapies
Favorite Tool

Aka The Short Essensials Teaching Tool for Superiority Trials for Therapies
Version 05/24/2014

Novice/
Intermediate teaching tool, self-study guide, reminder tool

Quick appraisal process steps and is generally descriptive

[PDF]
[
WORD]

 

1-Pager
Quick Checklist for Efficacy of Therapeutic Interventions (with supplemental questions for diagnostic testing and screening)

Favorite Tool

Aka The "Short" Delfini Critical Appraisal Checklist
Version
05/23/2014

All levels for reviewing with articles

Assumes user possesses core competencies in critical appraisal

[PDF] [WORD]

1-Pager
Pearls: Reminders for Validity Detectives for Critical Appraisal for Efficacy of Therapies

Version 03/11/2011

Novice process key points

Similar to above 2 tools, but very process oriented

 

[PDF] [WORD]

CRITICAL APPRAISAL
Primary Studies
: Comprehensive Tool

~11 Pages
Primary Studies: Long Tool
Short EBM "Textbook"
Favorite Tool

Version 02/14/2013

Explains concepts in the short tools and more; teaching tool, self-study guide [PDF]
[WORD]

CRITICAL APPRAISAL: Comparative Designs

1-Pager
Comparative Study Designs of Clinical Trials (Equivalence and Non-inferiority Trials)
(see also Primers)

Favorite Tool

Version 05/23/2014

Considerations for non-inferiority and equivalence trials

[PDF]
[WORD]

CRITICAL APPRAISAL: Cross-over Designs

1-Pager
Cross-over Designs

Version 03/17/2014

Considerations [PDF]
[WORD]
: Diagnostic Testing

1-Pager
Pearls: Diagnostic Testing

Favorite Tool

Version 07/30/2010

Considerations [PDF]
[WORD]
Diagnostic Testing Calculator For calculating measures of test function and getting results in natural English [Excel] 
: Screening 1-Pager
Screening

Version 07/30/2010

Considerations [PDF]
[WORD]
: Oncology 1-Pager
Chart of Oncology Outcomes

Favorite Tool

Version 10/01/2010

Chart of various outcomes with issues discussion [PDF]
[WORD]
RESULTS
ASSESSMENT
  
1-Pager
Analyzing Results

IMPORTANT: Includes information on assessing confidence intervals (also see Primers)
Favorite Tool

Version 02/17/2014

Tips on assessing results and determining meaningful clinical benefit [PDF]
[WORD]
1-Pager
Composite Endpoints

Version 07/15/2014

Considerations [PDF]
[WORD]

1-Pager
Intention-to-Treat (ITT) Analysis

Favorite Tool

Version 11/02/2012

Considerations

[PDF] [WORD]

ITT Recalcuation Spreadsheet Aids with assignng missing values and re-computing p-value [Excel]

1-Pager
Time-to-Event-Analysis

Favorite Tool

Version 10/10/2013

Considerations [PDF] [WORD]
SAFETY

1-Pager
Pearls: Safety

Version 11/20/2010

Considerations [PDF] [WORD]

SAFETY &
REGISTRIES

1-Pager Registry Evaluation Checklist: Safety of Interventions
Critical appraisal considerations for evaluating registries for use for safety assessments and safety studies.

Version 11/23/2010

Considerations [PDF]
[WORD]
CRITICAL APPRAISAL
Secondary Studies
& Secondary Sources

1-Pager on Working with Secondary Resources

Secondary studies & sources such as guidelines should be critically appraised. See tools below. Also the scientific content used in the source should be critical appraised or, at the very least audited—these are pearls for how to do that.

Version 05/23/2014

Principal advice for working with secondary studies & sources including audit advice [PDF] [WORD]
CRITICAL APPRAISAL
Secondary Studies
: Short Tool

1-Pager
Pearls: Basics of Evaluating Secondary Studies (including meta-analyses)

Version 05/23/2014

Novice/
Intermediate teaching tool, self-study guide, reminder tool

[PDF]
[WORD]

 

CRITICAL APPRAISAL
Secondary Studies
: Comprehensive Tool

~10 Pager
Systematic Review Tool
Favorite Tool

Version 01/29/2013

Principal tool for appraising secondary studies; teaching tool, self-study guide [PDF]
[WORD]
CRITICAL APPRAISAL
Secondary Sources
: Short Tool

1-Pager
Pearls: Basics of Evaluating Secondary Sources (eg, clinical guidelines, pathways, clinical recommendations, disease management protocols)

Version 09/07/2010

Novice/
Intermediate teaching tool, self-study guide, reminder tool

[PDF]
[WORD]

 

CRITICAL APPRAISAL
Secondary Sources
: Comprehensive Tool

~10 Pager
QI Project Appraisal Tool

Secondary Sources reference primary and secondary studies (e.g., clinical guidelines, disease management protocols, pathways, etc.)
Favorite Tool

Version 04/11/2013

Principal tool for appraising secondary sources; teaching tool, self-study guide [PDF]
[WORD]
CRITICAL APPRAISAL
Economic Studies
: Comprehensive Tool

2-Pager
Healthcare Economic Study Review Tool

Favorite Tool

Version 01/29/2013

Principal tool for appraising any economic studies such as cost-effectiveness analyses and pharmacoeconomic studies; teaching tool, self-study guide [PDF]
[WORD]

1-Pager
QALYs

Version 10/30/2012

Key Points about QALYs [PDF]
[WORD]
CONCLUDING & SUMMARIZING  

1-Pager
Grading

Version 07/01/2013

Short advice on evidence grading [PDF]
[WORD]

Grading, Wording Conclusions and Results Table Tool
Favorite Tool 

Version 07/01/2013

Principal tool for advice on grading and wording; results table tool is a cut-and-paste utility

Also information on systems GRADE and AHRQ-EHCP

[PDF] [WORD]

Ideal Study Parameters

Version 01/30/2013

Preparation for scientific review [PDF]
[WORD]

1-Pager
Evidence Synthesis Overview

Version 08/02/2013

Short advice on creating an evidence summary [PDF]
[WORD]

Evidence Synthesis Tool

Version 01/30/2013

Tips for combining results from multiple studies [PDF]
[WORD]

The Delfini Decision-support Semaphore Example: MRI for Women at High Risk of Breast Cancer

Favorite Tool 

Version 03/01/2011

Multiple examples

Example of a way to present highly complex evidence-based information and other considerations

[PDF]
[WORD] for MRI only

 

[PDF]
[WORD]
for sampler including MRI

Qualitative Systematic Review Template Master document for assembling a scientific review and report generation Available only through Delfini Programs

DOCUMENTATION
: Primary Studies

Study Summary & Critique For online documentation for project work [WORD]
Mini-online application version

For online documentation for project work

[WORD]

Quick Appraisal Topic Report Form

Also contains a short list of some of our favored sources!

Version 01/30/2013

Another mini! It's good to have various formats to report evidence findings depending on needs. This one is a shorty for when your time is limited and you need to keep the report brief. Quick process steps included.

[WORD]

Search Documentation

Version 01/30/2013

For online documentation for project work [WORD]
[PDF]
Critical Appraisal Primers & White Papers
Evidence Essentials—Critical Appraisal Online Tutorial: A brief (and hopefully fun) online tutorial on the basics of critical appraisal of therapeutic interventions. The emphasis is on evaluating efficacy claims of primary studies using superiority designs.
Topic Item User Info Get
Study Design Issues  

Case Series

Version 01/31/2013

Problems with [PDF]

Observations for Interventions

Favorite Tool

Version 01/31/2013

General weaknesses of observations [PDF]

Problems Narrative Reviews

Version 01/31/2013

Problems with [PDF]
Various Topics How to Read a Forest Plot

Favorite Tool
Version 11/23/2013

Teaching aid, self-study guide [PDF]
Confidence Intervals & Their Use for Interpreting Significance of Results
Favorite Tool
Version 11/23/2013
Teaching aid, self-study guide [PDF of Slides]

Correlation Analysis
Version 06/13/2011

1-pager

[PDF]
[WORD]

"Real World" Data
Version 11/08/2012

1-pager

[PDF]

Evidence-based Committee Help
Topic Item User Info Get
General

EBM Committee Tips Tool

Version 01/30/2013

General operational suggestions for leaders [PDF]
[WORD]
Committee Members

On Being An Effective Evidence-based Committee Member

New 05/2013

Roles, responsibilities and ideals [PDF]
[WORD]
Formulary Management
: Comprehensive

Committee Deliberations Tool & EBM Pharmacy & Therapeutics Committee Tips Tool

Favorite Tool

Sequential steps and detailed tips for effective committee functioning and decision-making

Available only through Delfini Programs

Formulary Management
: Member Checklist

1-Pager
Considerations list for committee members

Teaching aid, self-study guide, committee utility tool Available only through Delfini Programs
Formulary Management Publications  Monograph and systematic review preparation help Online at links to the left
Medical Technology Assessment
: Comprehensive
EBM Medical Technology Assessment Committee Tips Tool

Favorite Tool

Sequential steps and detailed tips for effective committee functioning and decision-making Available only through Delfini Programs
Quality Improvement Project Mangement Help
Topic Item User Info Get
Evidence-based Clinical Quality Improvement (EBCQI)
: Short Tool

1-Pager
High level overview of evidence-based clinical quality improvement considerations

 

Key considerations for the Evidence‐ & Value‐based Organization
and for Evidence‐ and Value‐based Clinical Quality Improvement efforts
[PDF]
: Comprehensive Tool Suggestions for Evidence-based Quality Improvement Team Operations: Conducting Projects
Favorite Tool 
Sequential steps and detailed tips for creating and managing EB-QI teams and projects Available only through Delfini Programs
Project Development

Project Proposal Tool

Version 01/30/2013

Considerations [PDF]
[WORD]
Impact Assessment

Project Change Assessment Tool

Version 01/29/2013

Key considerations in addition to cost [PDF]
[WORD]
Impact Assessment Scenario Flowing Evidence into Cost Analysis: Powerful Ways with NNT A little illustration of some helpful ways to use NNT Online
Implementation

Project Implementation Strategies and Tool
Favorite Tool

Version 01/29/2013

Strategies for creating behavior change and implementing projects

[PDF]
[WORD]

Measurement
: Primer
2-Pager
Quality Measurement Efforts

Favorite Tool 

Version 01/31/2013

Teaching aid, self-study guide [PDF]
Performance Measurement
: Comprehensive

Performance Measures (including selecting good projects)

Version 01/29/2013

See also Delfini Publication Page: Performance Measurement

Sequential steps and detailed tips for development, implementation and reporting of performance measures, evaluating the validity and usefulness of measures, avoiding measurement pitfalls and more [PDF]
[WORD]
Cost Analysis Help

See Critical Appraisal Tools for "Healthcare Economic Study Review Tool"

   
Evidence Outcomes into Cost

NNT Comparison Calculator

A spreadsheet calculator to do NNT conversions for cost analysis [Excel]
More Cost Analysis Tools & Ideas

Electronic Spreadsheet Templates & Approaches (for ideas only!)
Example for projecting impacts of change - Hypothetical Venous Ulcer Project [PDF] & [Excel] (There is no guarantee on the formulas, utility or anything else — you will need to examine closely and apply your own Excel skills and common sense to use!)

& Approaches (example online at On The Same Page™ - Flowing Evidence into Cost Analysis: Powerful Ways with NNT)

IBS Example — Impact Assessment Template & Sample: Spreadsheet template included as an optional, customizable aid designed to help health care organizations project potential changes which may result from successful guideline implementation. A completed tool is included as an example and was constructed using assumptions generated through meetings with national medical leaders. Overwrite these assumptions to reflect your own along with your local conditions. Use to perform sensitivity analyses. Useful, when modified, for other clinical improvement projects. Click here to download the sample tool — Impact Assessment Template [Excel]

Patient Tools for Healthcare Providers (& One for Patients)
Topic Item User Info Get
Information Development Help

Patient Information & Decision Aids Tool

Version 01/29/2013

Considerations for patient communication tools [PDF]
[WORD]
Decision Support Help

Rx Messaging Scripts Template
(Messaging script examples are available online.)
Favorite Tool

Version 01/29/2013

Treatment messaging & decision support tools for specific clinical topics

[PDF]
[WORD]

Engagement Help

GLIDE Patient Information & Engagement Encounter Map

  • Greet
  • Listen
  • Inquire & Exchange Information
  • Determine & Decide
  • End Encounter

Favorite Tool

Version 01/29/2013

Communication tool for physicians and others who directly engage with patients to provide information, decision and action-oriented information during clinical encounters [PDF] [WORD]
General Help On the Same Page ™ — for Practitioner/Patient Information & Decision Aids A variety of patient-centered readings, examples and help Online at links to the left
General Help for the Evidence-based Organization
Topic Item User Info Get
The EBM Organization & Evidence-based Clinical Quality Improvement (EBCQI)
: Short Tool

1-pager
Pearls: Outline of Key Considerations for the Evidence- & Value-based Organization
and for Evidence- and Value-based Clinical Quality Improvement Efforts

Favorite Tool

Version 09/10/2010

 

Tool for helping health systems organize for an evidence-based approach

[PDF]
[WORD]
The EBM Organization

Health Care Quality System Assessment Tool
Favorite Tool

Version 01/29/2013

Tool for assessing how prepared organizations are to apply an evidence-based quality approach; requirements [PDF]
[WORD]
EBM Organization Publications American College of Physician Executives publication page: The EBM Organization 3-part series General information Online at links to the left
Miscellaneous Other Tools

Delfini Law & Medicine Tool

  1. Checklist for Evaluating the Evidence-based Medicine Approach of Medical “Experts” [PDF][WORD] Version 01/31/2013

Delfini Meeting & Office Management Tools (see above in various sections for EBM Committee tools)

  1. Effective & Efficient Meetings [PDF][WORD] Version 01/31/2013Webinar Tips [WORD] Version 01/30/2013

Research Searching Tips
Caveats abound! A number of years ago, I was asked to lead a session on research searching at UCSD. I make no claims to the utility or completeness of this document — plus this was specifically geared to UCSD faculty, staff and students. But in case this is useful to someone else, here 'tis. [PDF] Sheri

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