MODIFIED CAT Guide: Pre-Appraised Literature
LeFebvre (8/28/12)
Team #:
1.
General Topic Area:
Date completed:
First revision date:
Second revision date:
1
Bottom Line:
2
Study Type(s) the evidence is based on: Mark all that apply.
RCT
Cohort
Case control
Case series/Case report
Qualitative systematic review
Meta-analysis
Guidelines
Prospective design
Retrospective design
3
What search terms did you use?
What sources were the most useful to answer your particular question?
Cross sectional
Clinical Prediction Rule
Other (identify)
Bottom Line.
The EIP sandwich
This section should be no more than 2-3 sentences long, but it should
have enough detail to convey to the reader the key useful clinical
information along with its quality and effectiveness/accuracy. Pretend
that this was the only section that someone might read. Think of the
bottom line as a sandwich. The “meat” is the take-home message from
the study. The rest of the sandwich consists of 2 parts. NOTE: When
studies come to different conclusions, you will need to take that
into account.
Part 1. How effective was the treatment? This should be expressed in numbers. In the case of therapy studies, you
should also indicate whether the improvement was statistically significant (indicated by the p-value) and whether it
was large enough to be clinically significant too. Special warning: if you still don’t understand the difference between
statistical significance and clinical significance/importance, read the document called P Values, Statistical
Significance & Clinical Significance.
Part 2. What is the quality of the evidence? Don’t just say that the study was an RCT which is “very high on the
evidence pyramid.” In addition to the type of evidence (e.g., systematic review, RCT, double blind RCT, cohort)
indicate what you thought of the quality of that evidence. Indicate whether the evidence in general and any particular
study was high quality, moderate quality, or low quality. Indicate why you think this.
Example of a brief EIP sandwich with all three ingredients: In uncomplicated sinusitis, patients shouldn’t be
referred for antibiotic therapy. An NNT of 9 was not considered effective enough weighed against the needless
exposure to antibiotics. This is based on a 2008 meta-analysis of 9 RCTs. Journal of Family practice gave this
practice tip an A level recommendation.
2.
Study Type(s). Check the type of studies that your article summarizes or critiques.
3.
Indicate what grouping of search terms you used. Also cite which of the various sources were most helpful for this
particular question.
Clinic Phase 2
Pre-Appraised Literature Assignment
Page 1 of 2
4
5
Summarize the evidence that you found from various sources (include type of studies and strength of
evidence).
Clinical Application (usefulness in our setting):
References:
6
7
7
Main primary studies/reviews cited by the article (list the 3 most useful):
Approximate time to complete the lit search? This is the time devoted to exploring and familiarizing yourself with
the 4 resources and selecting the articles you wanted to read. Estimate how long this took (round out into fractions
of an hour, e.g., ¼, ½, 1 hour).
each team member
indicating
by the
intials
Approximate
time to
complete
CAT? This is the time devoted to reading the article and writing the CAT.
Estimate how long this took (round out into fractions of an hour, e.g., ¼, ½, 1 hour).
CAT Author:
4.
Summary of the evidence.
Part 1 Brief description of the numbers and types of studies your summary is based on. Be sure to report the
size of the test population(s) from the various studies included and exactly what the intervention and control groups
were (depending on the type of evidence).
Part 2 Cite the therapeutic effectiveness.
Address each of the following (if some information is not contained in the article, indicate “not reported”; if it doesn’t
apply as in the case of a cohort study, indicate “N/A”):
o
o
o
o
o
When reporting therapeutic results, be sure to make a distinction between statistical significance and clinical significance.
Present quantitative results for each claim. For therapy studies results must be reported as change in median pain or disability socres,
effect size, NNTs, odds ratios and/or risk reduction depending on what’s in the article).
Sometimes a strength of recommendation rating is also given. You should cite it. Be sure to explain any rating system used.
Any side effects should also be cited.
Note: In all cases, include confidence intervals (or standard deviations) if they were reported.
Part 3 Cite the strength of the evidence and strength of any recommendations that you discovered. Cite the
type of evidence it is based on (RCT? cohort study? clinical opinion)? But you must also cite the quality of that study if
it is known (or can be determined). Include quality score, overall estimation of high quality or low quality, strength of
recommendation, etc. If the evidence is of low quality explain why.
If you are including information from a systematic review, include





what data bases used
time period covered
how studies were assessed for quality (or were they)
number of studies & patients included.
Whether the systematic review itself was well done (e.g., broad enough search? Assessed quality of the evidence?)
If you are including information from a clinical guideline, include


5.
Strength of recommendation
Level of evidence
Clinical Application. Indicate whether you would apply this treatment/test in practice. Explain whether you think
o
o
o
The evidence is strong enough to trust
Is there sufficient similarity to the patients studied--clinical applicability (e.g., severity of condition, practice setting, age, gender)?
Is the application practical (cost, skill level required)?
6.
References. Cite the key study or studies you are basing your bottom line on.
7.
Approximate time to complete the lit search? And Approximate time to complete the CAT?
Clinic Phase 2
Pre-Appraised Literature Assignment
Page 2 of 2