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  • Why is it important? Critical appraisal is important because it:ensures a comprehensive assessment of the whole paperallows you to identify the strengths and weaknesses of a piece of researchdevelops an improved understanding of the research methodology used to conduct the researchallows you to relate the published research to your local situationenables you to identify any bias in the researchfacilitates the implementation of effective interventions in your clinical practice How do you critically appraise an article?The process of critical appraisal can be very time consuming. It requires you to carefully read the whole article, especially the research methodology and statistical analysis - not just the "easy" bits like the introduction, results and conclusion sections!When reading an article you need to consider the following:Who has written the article? Are they a recognised author. Are they affiliated to a recognised institution?Why? What are the aims and objectives?How? Has the right research methodology been used?When? Is it recent or seminal research?Where? Has it been published in a recognised journal? Is it a peer reviewed journal?Do the results seem valid?Does the statistical evidence seem valid?Is there any obvious bias or conflict of interests?Do the conclusions stack up?
  • 2. Reading a scientific paperAlthough it is tempting to read the paper straight through as you would do with most text, it is more efficient to organize the way you read. Generally, you first read the Abstract in order to understand the major points of the work. The extent of background assumed by different authors, and allowed by the journal, also varies as just discussed.One extremely useful habit in reading a paper is to read the Title and the Abstract and, before going on, review in your mind what you know about the topic. This serves several purposes. First, it clarifies whether you in fact know enough background to appreciate the paper. If not, you might choose to read the background in a review or textbook, as appropriate.Second, it refreshes your memory about the topic. Third, and perhaps most importantly, it helps you as the reader integrate the new information into your previous knowledge about the topic. That is, it is used as a part of the self-education process that any professional must continue throughout his/her career.If you are very familiar with the field, the Introduction can be skimmed or even skipped. As stated above, the logical flow of most papers goes straight from the Introduction to Results; accordingly, the paper should be read in that way as well, skipping Materials and Methods and referring back to this section as needed to clarify what was actually done. A reader familiar with the field who is interested in a particular point given in the Abstract often skips directly to the relevant section of the Results, and from there to the Discussion for interpretation of the findings. This is only easy to do if the paper is organized properly.CodewordsMany papers contain shorthand phrases that we might term 'codewords', since they have connotations that are generally not explicit. In many papers, not all the experimental data are shown, but referred to by "(data not shown)". This is often for reasons of space; the practice is accepted when the authors have documented their competence to do the experiments properly (usually in previous papers). Two other codewords are "unpublished data" and "preliminary data". The former can either mean that the data are not of publishable quality or that the work is part of a larger story that will one day be published. The latter means different things to different people, but one connotation is that the experiment was done only once.
  • Ask for volunteers, or select at least 3 to share
  • Definition #1
  • What is a systematic review?A systematic review is a review of scientific studies on a specific topic. It uses a formal process to:Identify all relevant studiesAssess their qualitySummarize the evidenceTop of pageSystematic reviews help make sense of large bodies of scientific literature by applying the scientific process to:Reduce bias in how conclusions are reachedImprove the power and precision of results Summarize evidence about the effectiveness of particular approaches for addressing a public health problemAnalyze generalizability of findings Identify knowledge gaps and need for additional research
  • A clearly defined, focused review begins with a well framed question. In Cochrane reviews, questions are stated broadly as review ‘Objectives’, and specified in detail as ‘Criteria for considering studies for this review’.There are seven steps for preparing and maintaining a systematic review, as outlined in the Cochrane Handbook:Formulating a problemLocating and selecting studiesCritical appraisal of studiesCollecting dataAnalyzing and presenting resultsInterpreting resultsImproving and updating reviews
  • The VERDICT Investigators conduct each systematicreview according to the procedures and criteria outlinedin the Cochrane Collaboration’s Reviewer’s Handbook[13]. These steps include:1. formulate the problem2. locate and select the studies3. assess study quality4. collect the data5. analyze and present the results6. interpret the results7. improve and update the results
  • I will begin with the end result- an example
  • The full text article in JAMANolte structure in red box
  • Pause here…if there is time

Transcript

  • 1. Critical Appraisal and the Systematic Review of the Literature
    Sources: JAMA :
    User’s Guide to the Medical Literature
    Young, J. M., & Solomon, M. J. (2009). How to critically appraise an article. Nature Clinical Practice.Gastroenterology & Hepatology, 6(2), 82-91. doi:10.1038/ncpgasthep1331
    1
  • 2. Learning Objectives
    Describe the critical appraisal process and how it relates to a systematic review
    Describe the purpose of a systematic review
    List the steps in the systematic review process
    Critically appraise a selected article (the one you found this week!)
    2
  • 3. What is critical appraisal?
    A systematic process used to identify the strengths and weaknesses of a research article in order to assess the usefulness and validity of the research findings.
    …most important are an evaluation of the appropriateness of the study design for the research question and a careful assessment of the key methodological features of this design…
    Young, J. M., & Solomon, M. J. (2009). How to critically appraise an article. Nature Clinical Practice.Gastroenterology & Hepatology, 6(2), 82-91. doi:10.1038/ncpgasthep1331
    3
  • 4. How to Read a Scientific Paper
    …first read the title and abstract…
    Review in your mind what you know about the topic…
    Allows you, as the reader, integrate the new information into your previous knowledge about the topic. That is, it is used as a part of the self-education process that any professional must continue throughout his/her career.
    If you are very familiar with the field, the Introduction can be skimmed or even skipped... the logical flow of most papers goes straight from the introduction to results…the paper should be read in that way as well…
    by John W. Little and Roy Parker--University of Arizona:
    http://www.biochem.arizona.edu/classes/bioc568/papers.htm#reading
    4
  • 5. Top Ten Questions to Ask:
    Is the study question relevant?
    Does the study add new knowledge?
    What type of research question is being asked?
    Was the study design appropriate to the research question?
    Was bias addressed?
    Young, J. M., & Solomon, M. J. (2009). How to critically appraise an article. Nature Clinical Practice.Gastroenterology & Hepatology, 6(2), 82-91. doi:10.1038/ncpgasthep1331
    5
  • 6. Questions, continued…
    Was the study performed according to the original protocol?
    Did the study test a stated hypothesis?
    Were the statistical analyses performed correctly?
    Do the data justify the conclusions?
    Are there conflicts of interest?
    Young, J. M., & Solomon, M. J. (2009). How to critically appraise an article. Nature Clinical Practice.Gastroenterology & Hepatology, 6(2), 82-91. doi:10.1038/ncpgasthep1331
    6
  • 7. How is s critical appraisal accomplished?
    7
  • 8. Discuss your article
    Database(s) searched
    General topic area researched
    Did you find a lot, too little, too much?
    Article title
    Type of research question/hypothesis
    Was bias addressed?
    Did the data justify the conclusions?
    Other comments you want to share…
    8
  • 9. 9
  • 10. What is a systematic review?
    A systematic review is a review of scientific studies on a specific topic. It uses a formal process to:
    Identify all relevant studies
    Assess their quality (critical appraisal)
    Summarize the evidence
    Source: http://www.thecommunityguide.org/about/methods.html
    10
  • 11. Whydo a systematic review?
    Systematic reviews help make sense of large bodies of scientific literature by applying the scientific process to:
    Reduce bias in how conclusions are reached
    Improve the power and precision of results
    Summarize evidence about the effectiveness of particular approaches for addressing a problem
    Analyze generalisability of findings
    Identify knowledge gaps and need for additional research
    Source: http://www.thecommunityguide.org/about/methods.html
    11
  • 12. What you will accomplish…
    Clearly formulate/state the research question
    Develop the research protocol
    Conduct the literature search
    Complete data extraction after developing a form
    Appraise the quality of the selected studies
    Analyze the data and results in narrative and tabular formats
    Interpret the results, including the strengths and weaknesses of the studies
    12
  • 13. Systematic review methodology …
    Were all relevant studies included/excluded?
    Were selected articles appraised and data extracted?
    Was their sufficient detail?
    Was the quality of the primary studies assessed?
    Did researchers assess appropriateness of combing results?
    Young, J. M., & Solomon, M. J. (2009). How to critically appraise an article. Nature Clinical Practice.Gastroenterology & Hepatology, 6(2), 82-91. doi:10.1038/ncpgasthep1331
    13
  • 14. The Systematic Review Process
    14
  • 15. 15
  • 16. An example from JAMA via PubMed
    16
  • 17. 17
  • 18. Useful Resources
    AHSL EBM Search Engine- http://www.ahsl.arizona.edu/ebmsearch/index.cfm
    BU Alumni Medical Library: Conducting a Systematic Review(under Subject-Specific Tutorials)
    Data Extraction Form Samples: www.cochrane.iwh.on.ca/pdfs/data_extract_04.pdf and http://www.iss.it/binary/neph/cont/Data%20extraction%20form.1183648415.pdf
    Searching the Cochrane Database
    The Centre for Evidence-Based Medicine - Systematic Review of a Therapy Worksheet
    Washington University St Louis Becker Library Evidence at Becker
    What is a Systematic Review? (from the BMJ)
    Wikipedia: http://en.wikipedia.org/wiki/Systematic_review
    18
  • 19. Take time now to answer these:
    What type of research question was asked.?
    Did the study address the key potential sources of bias? Explain.
    What is the stated hypothesis of the study?
    Did the data adequately justify the conclusions? Discuss.
    19
  • 20. Did we accomplish the Learning Objectives
    Describe the critical appraisal process and how it relates to a systematic review
    Describe the purpose of a systematic review
    List the steps in the systematic review process
    Critically appraise a selected article
    20
  • 21. Thanks….questions??
    JDDoyle@email.arizona.edu
    Office: 602-827-2062
    Mobile/Text: 602-689-5976
    21