Introduction to Evidence-Based Medicine

William J. Powers, M.D.-- Departments of Neurology, Neurosurgery and Radiology
Washington University School of Medicine -- Presented July 11, 2006

Evidence-Based Treatment of Cerebrovascular Disease

The following lecture is part of an ongoing series of lectures that discuss the current state of evidence supporting different treatments for the most common types of cerebrovascular disease.

This lecture will cover some basic principles of evidence based medicine. We will discuss different types of evidence, their validity and sources of bias. Pros and cons of different methods to measure therapeutic effects will be addressed. Some of the problems in trying to apply the evidence-based approach in the real world will be covered.


1. Some principles of evidence-based medicine
2. Financial disclosures
3. Quality of evidence
4. Current state of empirical evidence
5. Hierarchy of clinical evidence quality
6. N of 1 (Single Patient) randomized clinical trial I
7. N of 1 (Single Patient) randomized clinical trial II
8. Generalizing from clinical evidence
9. Meta-analysis
10. Secondary prevention of stroke with aspirin and dipyridamole
11. European Stroke Prevention Study 2
12. Secondary prevention of stroke with aspirin and dipyridamole II
13. Secondary prevention of vascular events in high-risk patients
14.The "gold standard" of clinical trials is -
15. The randomized, masked, parallel-group clinical trial
16. Evaluating a parallel group clinical trial
17. Intent-to-treat analysis
18. The primary endpoint I
19. The primary endpoint II
20. Comparison of drug-eluting stent with standard stent
21. tPA for Acute Ishemic Stroke (NINDS)
22. Biomarkers and surrogate endpoints
23. Validation of a biomarker as a surrogate endpoint
24. Failure of a biomarker as a surrogate endpoint: encainide
25. Failure of a biomarker as a surrogate endpoint: ALLHAT trials
26. Reductions in mortality vs. total cholesterol difference
27. Power
28. HAEST trials
29. Observational studies
30. Treatment of diabetic ketoacidosis
31. Observational studies II
32. Warfarin aspirin study of intracranial disease
33. Divergent data on post-menopausal hormone therapy
34. Weakest inferences about treatment effects
35. Mechanical embolectomy in acute ischemic stroke: MERCI
36. Clinical expereince vs. clinical trial
37. Measuring the effects of therapy
38. Risk reduction
39. Comparison of aspirin with other anti-platelet agents
40. Number needed to treat
41. Number needed to treat to prevent 1 stroke 2 years after carotid endarterectomy
42. Translating evidence into recommendations
43. Factors that may change the strength of a recommendation
44. Translating evidence into patient care
45. Translating evidence into patient care subgroup analysis
46. Translating evidence into patient care: perils of subgroup analysis
47. Perils of subgroup analysis: Negative trials with "positive" subgroups
48. Citicholine in acute ischemic stroke
49. Perils of subgroup analysis: Positive trials with "negative" subgroups
50. Randomized, blinded trial of clopidogrel vs. aspirin
51.Problems in the "evidence" of "evidence-based medicine"
52. Further reading on evidence-based medicine





 

 

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