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    Are the outcome measures accurate and comprehensive? Large databases tend to include only simple out

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    1)Is there clear information about the method used to develop the standards, e.g. are the standards

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    1)Is there good evidence that the intervention used as the indicator of quality is an effective inte

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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

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    Was an incremental analysis of the costs and consequences of alternatives performed? [Were the addit

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    1) Were costs and consequences measured accurately in appropriate physical units (e.g. hours of nurs

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    1) Was there evidence that the programme's effectiveness had been established? [How strong was t

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    1) Was a well-defined question posed in an answerable form? 2)Was a comprehensive description of

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    1) Are the results applicable to the population in general? 2)Are the results relevant to the loc

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    1) How well did the survey assess the experience of the patients as opposed to their reaction to tha

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    1) How good is the instrument at measuring the three aspects of care that determine satisfaction: in

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    1) How has the instrument been tested? 2)What is the interobserver variability, i.e. how differen

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    1) Would the quality of training be important in determining the frequency of adverse effects? 2)

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    Were the professionals participating in the study more highly specialised or more experienced in thi

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    1) Was the assessment of outcomes free from bias? 2)Was there an adverse effect greater than woul

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    Is the service or treatment under investigation similar to that available locally in terms of: -

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    Is the study population similar to the local population: - genetically? - socially? - medic

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    If the trial results are positive and this treatment is being delivered within the local service, as

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    1) What is the magnitude of the beneficial effect? 2)With what degree of confidence can the findi

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    1) Do the authors identify or discuss how their own values could influence the interpretation of the

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    1) Is the definition of equity clearly set out in the article? 2)Is the definition of equity orig

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    Are the skills to deliver a service of adequate quality available locally? If not, is it possible to

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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

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    1) The smaller the effect predicted, the larger the trial required to produce a result. 2)The lar

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    1) The larger the sample of patients, the narrower will be the confidence intervals. 2)The narrow

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    1) Were the results of the research kept separate from the conclusions drawn by the research workers

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    1) Did the research workers address the issues of subjectivity and data collection? 2)Were method

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    1) Was the research question clearly identified? 2)Was the setting in which the research took pla

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    1) Why are nurses and doctors not able to work with one another with ease? 2)What difference has

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    1) Why do people not take the medicine prescribed for them? 2)Why do clinicians adopt innovations

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    1) A means of identifying whether there are biases in the collection of information or drawing of co

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    1) Has sensitivity analysis been used to test the effect of higher or lower utilities being assigned

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    1) Has sensitivity analysis been performed to determine whether the estimate of the incidence of sid

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    If utilities or disutilities have been used, were they based on surveys of people with the health pr

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    1) What proportion of the branches in the decision tree represent good data based on good-quality re

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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

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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

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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:

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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

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    1) Critical evaluation, 2)Incorporation into decisions. 3)Participation in the design, evaluat

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    1) Awareness of the existence of systematic reviews. 2)Perception of the advantages and disadvant

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    1) Was the searching technique limited to an electronic search of MEDLINE? 2)Are the results of t

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    1) Was the study described as randomised (this includes the use of words such as randomly, random, a

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    1) What are the overall results and how precise are they? 2)Will the results help in caring for p

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    1) Was the validity of the included studies assessed? 2)Were the assessments of studies reproduci

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    1) Did the review article address a focused question? 2)Is it likely that important, relevant stu

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    Despite the claims of some enthusiasts for RCTs, some important aspects of healthcare cannot be subj

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    Whatever those who question the value of healthcare interventions might think, many clinicians often

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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

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    The distinguishing features of research as defined in the NHS R&D Programme in the UK To repo

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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

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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

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    The principles underpinning the development of the NeLH 1.It will be obsessed with the quality of

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    The methods used to produce the knowledge can be displayed easily and completely so that the reader

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    1) The skills of librarians can be made available to a much wider range of users. 2)Knowledge can

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    1) The stock available is not limited by shelf space: small organisations can have as big an e-libra

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    1) Is there anyone else who could develop, or has developed already, a scanning strategy with whom I

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    1) How can I ensure that I do not miss important new knowledge using this strategy? 2)What checkl

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    1) How many hours each week do I want to spend scanning for new knowledge? 2)What sources of know

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    1)Were any other factors that could have produced the changes (other than the policy) identified in

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    1) Were data collected before and after the introduction of the new policy? 2)Was the follow-up o

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    1) Case-finding should be a continuing process and not a 'once and for all' project 2) We

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    The cost of case-finding (including diagnosis and treatment of patients diagnosed) should be economi

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    1) The natural history of the condition, including development from latent to declared disease, shou

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    1)There should be a recognizable latent or early symptomatic stage. 2)There should be a suitable

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    1) The condition sought should be an important health problem. 2)There should be an accepted trea

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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

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    1) Was the reproducibility of the test (precision) and its interpretation (observer variation) deter

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    Did the patient sample include an appropriate spectrum of mild and severe, treated and untreated dis

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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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