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TABLE 7-11: FIRST QUESTIONS ABOUT RISK OF BIAS BY TYPE OF SOURCE

               Type of source                          Appropriate questions about bias

           A trial or intervention  Was allocation randomized? Was attrition large? Was the
                    study             outcome measured the same way in both arms?


                                      Was confounding addressed? Could the selection of the sample
          An observational study
                                      or the measurement change the result?

                                      Is the sample justified? Is the coding deep? Is there reflexivity
             A qualitative study
                                      and support from quotations?

                                      Which body produced it? What was the purpose? How was the
          An institutional report
                                      indicator defined? Is there an interest in a particular result?



         TABLE 7-12: FACTORS THAT LOWER CERTAINTY IN A BODY OF EVIDENCE
                     Factor                                    Its practical meaning


                                        Could the design or the execution push the result in a particular
                  Risk of bias
                                        direction?

                                        Do  the  findings  agree  across  studies,  or  diverge  without
                 Inconsistency
                                        explanation?

                                        Is the evidence about a population, intervention, or outcome
                 Indirectness
                                        different from our question?


                                        Do  the  sample  sizes  or  the  intervals  make  the  conclusion
                  Imprecision
                                        unstable?

                Publication bias        Might negative or unpublished studies be missing?


         Say how certain the evidence is in modest language: “the evidence indicates”, “the evidence
         is  limited”,  “current  evidence  does  not  support  wide  generalization”,  rather  than  in

         categorical language the sources do not carry.
























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