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Are the outcome measures accurate and comprehensive? Large databases tend to include only simple out
Are the outcome measures accurate and comprehensive? Large databases tend to include only simple outcome measures, such as death, and rarely hold data on measures such as disability or quali...
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1)Is there clear information about the method used to develop the standards, e.g. are the standards
1)Is there clear information about the method used to develop the standards, e.g. are the standards set by taking the cut-off point for the top quartile of several services? 2.Is there on...
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1)Is there good evidence that the intervention used as the indicator of quality is an effective inte
1)Is there good evidence that the intervention used as the indicator of quality is an effective intervention? 2)Are there standards relating to acceptability and safety?...
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The aim of the programme is to reduce mortality from breast cancer in the population screened 1)
The aim of the programme is to reduce mortality from breast cancer in the population screened 1) To encourage the provision of effective acceptable treatment which has minimal psychologic...
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Monitoring quality standards 1)The Commission for Health Improvement 2)A National Framework fo
Monitoring quality standards 1)The Commission for Health Improvement 2)A National Framework for Assessing Performance 3)National Survey of Patient and User Experience....
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Setting quality standards 1)The National Institute for Clinical Excellence (NICE) 2)The Nation
Setting quality standards 1)The National Institute for Clinical Excellence (NICE) 2)The National Service Framework...
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1)Was allowance made for uncertainty in the estimates of costs and consequences? 2)Did the presen
1)Was allowance made for uncertainty in the estimates of costs and consequences? 2)Did the presentation and discussion of study results include all issues of concern to users?...
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Was an incremental analysis of the costs and consequences of alternatives performed? [Were the addit
Was an incremental analysis of the costs and consequences of alternatives performed? [Were the additional (incremental) costs generated by one alternative over another compared to the additi...
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1) Were costs and consequences measured accurately in appropriate physical units (e.g. hours of nurs
1) Were costs and consequences measured accurately in appropriate physical units (e.g. hours of nursing time, number of physician visits, lost work-days, life-years gained)? 2)Were costs ...
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1) Was there evidence that the programme's effectiveness had been established? [How strong was t
1) Was there evidence that the programme's effectiveness had been established? [How strong was the evidence of effectiveness?] 2)Were all the important and relevant costs and conseque...
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1) Was a well-defined question posed in an answerable form? 2)Was a comprehensive description of
1) Was a well-defined question posed in an answerable form? 2)Was a comprehensive description of the competing alternatives given (i.e. can you tell who did what to whom, where, and how o...
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1) Are the results applicable to the population in general? 2)Are the results relevant to the loc
1) Are the results applicable to the population in general? 2)Are the results relevant to the local population? 3)Were costs and consequences adjusted for differential timing?...
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1) How well did the survey assess the experience of the patients as opposed to their reaction to tha
1) How well did the survey assess the experience of the patients as opposed to their reaction to that experience? 2)Was the sample interviewed a representative sample of the population se...
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1) How good is the instrument at measuring the three aspects of care that determine satisfaction: in
1) How good is the instrument at measuring the three aspects of care that determine satisfaction: interpersonal care, the physical environment and clinical outcome? 2)How comprehensible a...
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1) How has the instrument been tested? 2)What is the interobserver variability, i.e. how differen
1) How has the instrument been tested? 2)What is the interobserver variability, i.e. how different are the answers if different people use the questionnaire on the same person?...
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1) Would the quality of training be important in determining the frequency of adverse effects? 2)
1) Would the quality of training be important in determining the frequency of adverse effects? 2)Were the patients in the research study different from those in the local population, eith...
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Were the professionals participating in the study more highly specialised or more experienced in thi
Were the professionals participating in the study more highly specialised or more experienced in this intervention than those who will be treating the local population?...
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1) Was the assessment of outcomes free from bias? 2)Was there an adverse effect greater than woul
1) Was the assessment of outcomes free from bias? 2)Was there an adverse effect greater than would be expected by chance, taking into account the confidence intervals?...
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Is the service or treatment under investigation similar to that available locally in terms of: -
Is the service or treatment under investigation similar to that available locally in terms of: - skills? - resources?...
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Is the study population similar to the local population: - genetically? - socially? - medic
Is the study population similar to the local population: - genetically? - socially? - medically?...
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If the trial results are positive and this treatment is being delivered within the local service, as
If the trial results are positive and this treatment is being delivered within the local service, ascertain how large the effect is at what risk and at what cost. (The NNT is of use in this ...
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1) What is the magnitude of the beneficial effect? 2)With what degree of confidence can the findi
1) What is the magnitude of the beneficial effect? 2)With what degree of confidence can the findings in a research setting be reproduced in ordinary clinical settings?...
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1) Do the authors identify or discuss how their own values could influence the interpretation of the
1) Do the authors identify or discuss how their own values could influence the interpretation of the findings? 2)Are there any data describing the opinions of individuals other than the a...
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1) Is the definition of equity clearly set out in the article? 2)Is the definition of equity orig
1) Is the definition of equity clearly set out in the article? 2)Is the definition of equity original or do the authors cite another source from which it was derived?...
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Are the skills to deliver a service of adequate quality available locally? If not, is it possible to
Are the skills to deliver a service of adequate quality available locally? If not, is it possible to develop those skills at an affordable cost?...
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1) Does the local healthcare service have the potential to reproduce the service provided in the tri
1) Does the local healthcare service have the potential to reproduce the service provided in the trial? 2)Could a similar level of resources as that available to the research workers be c...
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1) Does the population studied differ from the local population in ways that are likely to be import
1) Does the population studied differ from the local population in ways that are likely to be important with respect to: 2) genetic composition?...
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1) The smaller the effect predicted, the larger the trial required to produce a result. 2)The lar
1) The smaller the effect predicted, the larger the trial required to produce a result. 2)The larger the trial, the greater the power. 3)The greater the power, the narrower the confide...
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1) The larger the sample of patients, the narrower will be the confidence intervals. 2)The narrow
1) The larger the sample of patients, the narrower will be the confidence intervals. 2)The narrower the range of the confidence intervals, the greater will be the degree of confidence abo...
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1) Were the results of the research kept separate from the conclusions drawn by the research workers
1) Were the results of the research kept separate from the conclusions drawn by the research workers? 2)If quantitative methods were appropriate as a supplement to the qualitative methods...
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1) Did the research workers address the issues of subjectivity and data collection? 2)Were method
1) Did the research workers address the issues of subjectivity and data collection? 2)Were methods to test the validity of the results of the research used? 3.Were any steps taken to i...
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1) Was the research question clearly identified? 2)Was the setting in which the research took pla
1) Was the research question clearly identified? 2)Was the setting in which the research took place clearly described? 3.If sampling was undertaken, were the sampling methods described...
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1) Why are nurses and doctors not able to work with one another with ease? 2)What difference has
1) Why are nurses and doctors not able to work with one another with ease? 2)What difference has the involvement of doctors in management made to the management of health services?...
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1) Why do people not take the medicine prescribed for them? 2)Why do clinicians adopt innovations
1) Why do people not take the medicine prescribed for them? 2)Why do clinicians adopt innovations of unproven effectiveness and of unknown effect while failing to adopt innovations of pro...
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1) A means of identifying whether there are biases in the collection of information or drawing of co
1) A means of identifying whether there are biases in the collection of information or drawing of conclusions. 2)Why is it that people continue to smoke when the evidence about the harmfu...
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1) Has sensitivity analysis been used to test the effect of higher or lower utilities being assigned
1) Has sensitivity analysis been used to test the effect of higher or lower utilities being assigned to different options? 2)Have all the costs that should be taken into account been incl...
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1) Has sensitivity analysis been performed to determine whether the estimate of the incidence of sid
1) Has sensitivity analysis been performed to determine whether the estimate of the incidence of side-effects is higher or lower than the true incidence of side-effects? 2)Has sensitivity...
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If utilities or disutilities have been used, were they based on surveys of people with the health pr
If utilities or disutilities have been used, were they based on surveys of people with the health problem, surveys of a sample of the general population or estimates of the author's pers...
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1) What proportion of the branches in the decision tree represent good data based on good-quality re
1) What proportion of the branches in the decision tree represent good data based on good-quality research? 2)Has sensitivity analysis been performed to determine whether the estimate of ...
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Were the conclusions drawn from the survey all based on the data or did those carrying out the surve
Were the conclusions drawn from the survey all based on the data or did those carrying out the survey infer conclusions? Inference is acceptable, but it must be clearly distinguished from re...
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Was a validated questionnaire used? Did the authors of the survey mention the possibility of differe
Was a validated questionnaire used? Did the authors of the survey mention the possibility of different results being obtained by different interviewers, if interviewers were used?...
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1) How was the population to be surveyed chosen? Was it the whole population or a sample? 2)If a
1) How was the population to be surveyed chosen? Was it the whole population or a sample? 2)If a sample, how was the sample chosen? Was it a random sample or was it stratified to ensure t...
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1) Was the severity of disease taken into account in the analysis? 2)Was the presence of other di
1) Was the severity of disease taken into account in the analysis? 2)Was the presence of other diseases (co-morbidity) taken into account in the analysis? 3)What procedures were used t...
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1) If mortality is a criterion, what steps were taken to ensure that all deaths were identified?
1) If mortality is a criterion, what steps were taken to ensure that all deaths were identified? 2)If other criteria were used, have the instruments used for measurement been validated?...
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1) Is clear information given about the way in which the cohort was recruited? 2)Were any steps o
1) Is clear information given about the way in which the cohort was recruited? 2)Were any steps or decisions taken that could have included or excluded more severe cases?...
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1) How wide are the confidence intervals? 2)What were the exclusion and inclusion criteria? 3)
1) How wide are the confidence intervals? 2)What were the exclusion and inclusion criteria? 3)How similar were the patients in the trial to the 'local' patient group?...
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1) Was the difference consistent across studies? 2)Is there indirect evidence that supports the h
1) Was the difference consistent across studies? 2)Is there indirect evidence that supports the hypothesised difference? 3)Could the quality of service provided in the trial be reprodu...
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1) Is the magnitude of the difference clinically important? 2)Was the difference statistically si
1) Is the magnitude of the difference clinically important? 2)Was the difference statistically significant? 3)Did the hypothesis precede rather than follow the analysis?...
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Will the results help locally? Are the benefits worth the harms and costs? This is unlikely to be
Will the results help locally? Are the benefits worth the harms and costs? This is unlikely to be addressed by the trial. But what do you think?...
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Will the results help locally? Can the results be applied to the local population? Do you think t
Will the results help locally? Can the results be applied to the local population? Do you think that the patients covered by the trial are similar enough to your population?...
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What are the results? 1) How large was the treatment effect? What outcomes were measured? 2)Ho
What are the results? 1) How large was the treatment effect? What outcomes were measured? 2)How precise was the estimate of the treatment effect? What are its confidence limits?...
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1) Were patients, health workers and study personnel 'blind' to treatment? 2)Were the gro
1) Were patients, health workers and study personnel 'blind' to treatment? 2)Were the groups similar at the start of the study? In terms of other factors that might affect the out...
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1) Was follow up complete? 2)Were patients analysed in the groups to which they were randomised?
1) Was follow up complete? 2)Were patients analysed in the groups to which they were randomised? 3)Aside from the experimental intervention, were the groups treated equally?...
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1) Was the assignment of patients to treatments randomised? 2)Were all of the patients who entere
1) Was the assignment of patients to treatments randomised? 2)Were all of the patients who entered the trial properly accounted for at its conclusion?...
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Did the trial address a clearly focused issue? An issue can be 'focused' in terms of:
Did the trial address a clearly focused issue? An issue can be 'focused' in terms of: 1. the population studied; 2. the intervention given; 3. the outcomes considered....
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1) The smaller the effect expected in the treatment being tested, the larger the trial necessary to
1) The smaller the effect expected in the treatment being tested, the larger the trial necessary to have sufficient power to detect it. 2)The larger the trial, the greater its power....
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The defining features of an RCT In some types of RCT, such as drug trials, both doctor and patient m
The defining features of an RCT In some types of RCT, such as drug trials, both doctor and patient may be 'blind', i.e. unaware of whether the patient is a member of a treatment grou...
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The defining features of an RCT The assessment of outcome is made by an assessor who is unaware o
The defining features of an RCT The assessment of outcome is made by an assessor who is unaware of the patient's status; this is know as 'blind' assessment....
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The defining features of an RCT Individuals in the treatment group remain in that group irrespect
The defining features of an RCT Individuals in the treatment group remain in that group irrespective of whether they actually receive the intervention; for example, in a trial of breast c...
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The defining features of an RCT All entrants to the trial are followed up in treatment and contro
The defining features of an RCT All entrants to the trial are followed up in treatment and control groups....
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The defining features of an RCT The individuals who might benefit from the intervention are rando
The defining features of an RCT The individuals who might benefit from the intervention are randomly allocated to receive that intervention or not; the latter form the control group, and ...
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The defining features of an RCT There must be equipoise, that is, genuine doubt prior to the tria
The defining features of an RCT There must be equipoise, that is, genuine doubt prior to the trial about whether one option is better than another....
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1) Critical evaluation, 2)Incorporation into decisions. 3)Participation in the design, evaluat
1) Critical evaluation, 2)Incorporation into decisions. 3)Participation in the design, evaluation, and dissemination of findings....
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1) Awareness of the existence of systematic reviews. 2)Perception of the advantages and disadvant
1) Awareness of the existence of systematic reviews. 2)Perception of the advantages and disadvantages of using them. 3)Identification of individual reviews....
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1) Was the searching technique limited to an electronic search of MEDLINE? 2)Are the results of t
1) Was the searching technique limited to an electronic search of MEDLINE? 2)Are the results of the individual trials widely divergent? 3)Are all the individual trials in the meta-anal...
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1) Was the study described as randomised (this includes the use of words such as randomly, random, a
1) Was the study described as randomised (this includes the use of words such as randomly, random, and randomisation)? 2)Was the study described as double blind?...
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1) What are the overall results and how precise are they? 2)Will the results help in caring for p
1) What are the overall results and how precise are they? 2)Will the results help in caring for patients?...
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1) Was the validity of the included studies assessed? 2)Were the assessments of studies reproduci
1) Was the validity of the included studies assessed? 2)Were the assessments of studies reproducible? 3)Were the results similar from study to study?...
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1) Did the review article address a focused question? 2)Is it likely that important, relevant stu
1) Did the review article address a focused question? 2)Is it likely that important, relevant studies were missed? 3)Were the inclusion criteria to select articles appropriate?...
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Despite the claims of some enthusiasts for RCTs, some important aspects of healthcare cannot be subj
Despite the claims of some enthusiasts for RCTs, some important aspects of healthcare cannot be subjected to a randomised trial for practical and ethical reasons. Examples include the effect...
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Whatever those who question the value of healthcare interventions might think, many clinicians often
Whatever those who question the value of healthcare interventions might think, many clinicians often will not share their concern and will be opposed to an RCT; observational approaches can ...
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Observational data provide a realistic means of assessing the long-term outcome of interventions bey
Observational data provide a realistic means of assessing the long-term outcome of interventions beyond the time-scale of many trials. An example is long-term experience with different hip j...
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1) Some interventions, such as defibrillation for ventricular fibrillation, have an impact so large
1) Some interventions, such as defibrillation for ventricular fibrillation, have an impact so large that observational data are sufficient to show it. 2)Infrequent adverse outcomes would ...
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The distinguishing features of research as defined in the NHS R&D Programme in the UK To repo
The distinguishing features of research as defined in the NHS R&D Programme in the UK To report findings such that they are open to critical examination and accessible to all who coul...
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The distinguishing features of research as defined in the NHS R&D Programme in the UK To have
The distinguishing features of research as defined in the NHS R&D Programme in the UK To have defined arrangements for project management...
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The distinguishing features of research as defined in the NHS R&D Programme in the UK 1.To ha
The distinguishing features of research as defined in the NHS R&D Programme in the UK 1.To have been designed to follow a clear, well-defined study protocol. 2.To have had the stud...
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The distinguishing features of research as defined in the NHS R&D Programme in the UK 1.To pr
The distinguishing features of research as defined in the NHS R&D Programme in the UK 1.To provide new knowledge necessary for the improvement of the performance of the NHS in enhanci...
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The principles underpinning the development of the NeLH 1.It will facilitate action and interacti
The principles underpinning the development of the NeLH 1.It will facilitate action and interaction as well as providing knowledge. 2.It will enhance and build on existing libraries....
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The principles underpinning the development of the NeLH 1.It will be obsessed with the quality of
The principles underpinning the development of the NeLH 1.It will be obsessed with the quality of knowledge and not merely its quantity. 2.It will be equally open to patients, clinicia...
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The methods used to produce the knowledge can be displayed easily and completely so that the reader
The methods used to produce the knowledge can be displayed easily and completely so that the reader can appraise its quality....
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1) The skills of librarians can be made available to a much wider range of users. 2)Knowledge can
1) The skills of librarians can be made available to a much wider range of users. 2)Knowledge can be provided where and when it is needed. 3)Knowledge can be kept up to date quickly an...
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1) The stock available is not limited by shelf space: small organisations can have as big an e-libra
1) The stock available is not limited by shelf space: small organisations can have as big an e-library as big organisations. 2)Access is not limited to opening hours....
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1) Is there anyone else who could develop, or has developed already, a scanning strategy with whom I
1) Is there anyone else who could develop, or has developed already, a scanning strategy with whom I could share the load? 2)How can I review the benefits and weaknesses of this strategy ...
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1) How can I ensure that I do not miss important new knowledge using this strategy? 2)What checkl
1) How can I ensure that I do not miss important new knowledge using this strategy? 2)What checklists can I use to ensure that I stick to my scanning objectives? (A weekly checklist is us...
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1) How many hours each week do I want to spend scanning for new knowledge? 2)What sources of know
1) How many hours each week do I want to spend scanning for new knowledge? 2)What sources of knowledge do I want to scan regularly? 3.What sources of information will I exclude?...
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1)Were any other factors that could have produced the changes (other than the policy) identified in
1)Were any other factors that could have produced the changes (other than the policy) identified in the key criteria and discussed? 2)Were possible sources of bias in the research workers...
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1) Were data collected before and after the introduction of the new policy? 2)Was the follow-up o
1) Were data collected before and after the introduction of the new policy? 2)Was the follow-up of sufficient length to allow the effects of policy change to become evident?...
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1) Case-finding should be a continuing process and not a 'once and for all' project 2) We
1) Case-finding should be a continuing process and not a 'once and for all' project 2) Were the explicit policy objectives clearly stated? 3)Did the research workers identify a...
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The cost of case-finding (including diagnosis and treatment of patients diagnosed) should be economi
The cost of case-finding (including diagnosis and treatment of patients diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole....
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1) The natural history of the condition, including development from latent to declared disease, shou
1) The natural history of the condition, including development from latent to declared disease, should be adequately understood. 2)There should be an agreed policy on whom to treat as pat...
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1)There should be a recognizable latent or early symptomatic stage. 2)There should be a suitable
1)There should be a recognizable latent or early symptomatic stage. 2)There should be a suitable test or examination. 3)The test should be acceptable to the population....
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1) The condition sought should be an important health problem. 2)There should be an accepted trea
1) The condition sought should be an important health problem. 2)There should be an accepted treatment for patients with recognized disease. 3)Facilities for diagnosis and treatment sh...
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1) If the test is advocated as part of a cluster or sequence of tests, was its contribution to the o
1) If the test is advocated as part of a cluster or sequence of tests, was its contribution to the overall validity of the cluster or sequence determined? 2)Was the 'utility' of t...
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1) Was the reproducibility of the test (precision) and its interpretation (observer variation) deter
1) Was the reproducibility of the test (precision) and its interpretation (observer variation) determined? 2)Was the term 'normal' defined sensibly? (Gaussian, percentile, risk fa...
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Did the patient sample include an appropriate spectrum of mild and severe, treated and untreated dis
Did the patient sample include an appropriate spectrum of mild and severe, treated and untreated disease, plus individuals with different but commonly confused disorders?...
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1) Was the setting for the study, as well as the filter through which study patients passed, adequat
1) Was the setting for the study, as well as the filter through which study patients passed, adequately described? 2.Were the tactics for carrying out the test described in sufficient det...
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1) Are analytic methods used which differentiate whether characteristics affect diagnostic accuracy
1) Are analytic methods used which differentiate whether characteristics affect diagnostic accuracy or test threshold? 2.Was there an independent, 'blind' comparison with a 'g...
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Is the relation examined between estimates of diagnostic accuracy and study validity of the primary
Is the relation examined between estimates of diagnostic accuracy and study validity of the primary studies for each of the following design characteristics: - appropriate reference stand...
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1) When multiple test categories are available, are they used in the summary? 2)In comparative st
1) When multiple test categories are available, are they used in the summary? 2)In comparative studies, were all of the tests of interest applied to each patient or were patients randomly...
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1) Is a full listing of diagnostic accuracy and study characteristics given for each primary study?
1) Is a full listing of diagnostic accuracy and study characteristics given for each primary study? 2)Does the method of pooling sensitivity and specificity take account of their interdep...
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