Casp slides /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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  • 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  • 2. Critical Appraisal Skills Workshop find appraise act to help make sense of evidence about effectiveness Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 3. Questions • Think about some important questions you have posed in the course of your work in health care - alternatively think of some decisions you have had to make: what were the questions behind these decisions? • What’s the most common type of question posed? Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 4. Does it work? OR Is it effective? Question types predominate But there are others: • Equitable? • Efficient? • Appropriate? • Accessible? • Responsive? OR • How does it work? OR • Diagnosis/prognosis? Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 5. Where do we get our information? • What sorts of information do you use? • How do we know how truthful (valid) the information we use is? • What are the pros and cons of different types of information we use? Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 6. Influences on commissioning (or any health care decision) Professional advice Top down priorities Patients DECISIONResearchers WHO? Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 7. Influences on commissioning (or any health care decision) Guidelines Textbooks Peers EL’s White Papers Surveys Media DECISIONJournals WHAT? Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 8. Getting better information • Many sources of information • Should try to obtain the most truthful (valid) information • That is get the “evidence” to answer a particular question • Using critical appraisal Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 9. find appraise act ................ evidence about effectiveness To help make sense of …...................... Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 10. Objectives Recap on what clinical effectiveness is Explain the best way to measure effectiveness Explore why reviews are potentially the most efficient way to find evidence Explain some reviews jargon Show why reviews need to be systematic Give tips on where to find systematic reviews Explain how to critically appraise reviews so that you can spot the systematic ones and apply their results Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 11. Or put another way ...... • Knowing what you’re looking for • Knowing where to look for it • Understanding what you’ve got Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 12. What’s in this for you? Any user of information Any provider of information Researchers & reviewers APPRECIATE  () () APPRAISE  () APPLY LESSONS  Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 13.  What is clinical effectiveness? • Answer to question: Does it work? • Balance of beneficial and harmful effects • Generally needs qualification with information on: – Intervention (what you’re doing) – Individual/population (who you’re doing it to) – Outcome (what you’re trying to achieve) THUS: “Antibiotics are effective” - becomes • Penicillin by injection is effective in reducing deaths from meningococcal (bacterial) meningitis in all age groups Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 14. INSERT “Which to use cartoon”
  • 15.  Measuring clinical effects and effectiveness Intervention Population Outcomes Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 16.  Measuring clinical effects BY OBSERVING WHAT HAS HAPPENED Intervention Population Outcomes ANY PROBLEMS (BIAS)? “Experience” Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 17.  Measuring clinical effects BY CAREFULLY OBSERVING (RESEARCHING) WHAT HAS HAPPENED Intervention Population Outcomes ANY BIAS? “Retrospective observational research” Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 18.  Measuring clinical effects BY RESEARCHING WHAT HAPPENS AFTER INTRODUCING A NEW INTERVENTION Intervention Population Outcomes ANY BIAS? “Prospective case-series” Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 19.  Measuring clinical effects BY FORMALLY COMPARING WHAT HAPPENS AFTER INTRODUCING A NEW INTERVENTION Intervention Population Outcome No intervention; placebo; best available Population Outcome “Controlled trial” ANY BIAS? Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 20.  Measuring clinical effects BY COMPARING WHAT HAPPENS AFTER INTRODUCING A NEW INTERVENTION IN A WAY ENSURING EQUIVALENT GROUPS AT OUTSETP o p u l a t i o n Group 1 Group 2 Outcome Outcome Intervention No intervention; placebo; best available “Randomised controlled trial” Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 21.  Grading information - levels of evidence for clinical effects O n e stu d y A ll stu d ies R C T           C O N T R O L L E D T R IA L         C A S E -S E R IE S      O B S E R V A T IO N A L R E S E A R C H      E X P E R IE N C E    Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 22.  Why reviews? • Higher grade of information - likely to provide better evidence • Reveal new results or generate new lines of research • What problems have you had finding research information? CASPCritical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 23.  Why reviews? • TIME • skills • resources • more time! Identifying even a small representative selection of all available research requires: Bibliographic databases ?!? Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 24.  Why reviews? • But help required – understanding – finding – appraising Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 25. Meta -analysis Reviews Systematic reviews  Reviews jargon Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 26.  Reviews jargon ODDS RATIO (OR): Number comparing the effect of intervention on an outcome against a comparison group MEANING: A. OR = 1 number of outcomes in intervention group same as comparison group B. OR less than 1, less outcomes in intervention group C. OR more than 1, more outcomes in intervention group Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 27.  Reviews jargon ODDS RATIO (OR) continued: Consider an OR as a simple fraction: Outcomes in intervention group Outcomes in comparison group 1 death If both groups are the same size, 2 deaths the OR = 0.5, that is less than 1 because there are less outcomes in intervention group Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 28.  Reviews jargon Type of outcome VALUE OF OR Adverse outcome eg deaths Beneficial outcome eg stopped smokers Less than 1 eg 0.5 NEW INTERVENTION BETTER NEW INTERVENTION WORSE 1.0 exactly NEW INTERVENTION NO BETTER/WORSE NEW INTERVENTION NO BETTER/WORSE More than 1 eg 2.0 NEW INTERVENTION WORSE NEW INTERVENTION BETTER Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 29. 1 Bloggs 1987 Fred 1991 John 1991 Smith 1993 Summary 0.5 2.0  Reviews jargon “The blobbogram” BLOBS Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 30. 1 Bloggs 1987 Fred 1991 John 1991 Smith 1993 Summary 0.5 2.0  Reviews jargon “The blobbogram” WOBBLE - CONFIDENCE INTERVAL Which results are we confident about? Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 31. 1 Bloggs 1987 Fred 1991 John 1991 Smith 1993 Summary 0.5 2.0  Reviews jargon “The blobbogram” THE SUMMARY Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 32.  Why reviews need to be systematic • “Current medical reviews do not routinely use scientific methods to identify, assess and synthesise information.” (Mulrow, 1987) 50 reviews in 4 major journals, 1985-86 • No statement of methods 49 • Summary inappropriate 47 Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 33.  Why reviews need to be systematic Application of scientific principles • Formulate a question • Design a means to answer that question – search; sift; check; extract; summarise • Carry out the investigation • Draw conclusions Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 34.  Why reviews need to be systematic • In 7 primary care journals • 28 reviews identified in 1991 • Assessed on 8 criteria (being awarded up to two points for each - 16 in total) • Only 7 out of 28 scored 8/16 or more (Silagy, 1993) Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 35.  Why reviews need to be systematic (& up-to-date) • Information on best treatments for acute heart attack were identified from 182 RCTs and compared with advice in 143 reviews (articles & textbook chapters) at various times • “These data have uncovered discrepancies between the timeliness of recommendations by clinical experts and the meta-analytic evidence obtained by pooling RCTs.” (Antman, 1992) CASPCritical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 36. INSERT Table from Antman paper for thrombolytic agents
  • 37.  Why reviews need to be systematic (& up-to-date) “The clinical value of thrombolysis ... remains uncertain.” Oxford Textbook of Medicine, 1987 Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 38.  Why reviews need to be systematic • PUBLICATION BIAS • A tendency among investigators, peer reviewers and journal editors to allow the direction and statistical significance of research findings to influence decisions regarding submission and acceptance for publication. Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 39.  Finding systematic reviews - where? • Cochrane library – Cochrane Reviews – Database of Abstracts of Reviews of Effectiveness (DARE) – Trials database • HTA programmes – HNS – Wessex IPH CASPCritical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 40.  Finding systematic reviews - who might help? • Cochrane library - BMJ Publications • NHS Centre for Reviews & Dissemination, York • Regional centres eg ARIF • Local medical libraries Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 41.  Appraisal checklists for reviews • Is the review trustworthy / valid? – Screening questions – Detailed questions • What were the review’s results ? – Role of chance • How will the results help? – Relevance – What else do I need to know? Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP
  • 42. Objectives Recap on what clinical effectiveness is Explain the best way to measure effectiveness Explore why reviews are potentially the most efficient way to find evidence Explain some reviews jargon Show why reviews need to be systematic Give tips on where to find systematic reviews Explain how to critically appraise reviews so that you can spot the systematic ones and apply their results Critical appraisal skills ARIF University of Birmingham ACKNOWLEDGEMENT: This slide series is based on a format originally designed by CASP