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overveiw of critical apprasial
- 1. Dr. AMNA KHAIRY A.KAREEM MBBS(U of K)MPH (NU) DRME candidate Community Medicine lecturer EBM instructor Altababa and SEBMA Member. . 9/27/2018 1Amna Khairy
- 2. What is critical appraisal ? Importance of critical appraisal. Prerequisites to critical appraisal. Critical appraisal scheme . 9/27/2018amna khairy abdul kareem 2
- 3. What is evidence-based medicine? 9/27/2018amna khairy abdul kareem 3
- 4. integration of: 9/27/2018amna khairy abdul kareem 4 Best available research evidence Clinical expertise Patient’s values
- 5. 9/27/2018amna khairy abdul kareem 5 ask acquire appraiseapply asses
- 6. التثمين=appraisal 9/27/2018amna khairy abdul kareem 6
- 7. Is a systematic evaluation of clinical research papers in order to decide: Relevance Validity Results(Importance). Applicability of the of the results. 9/27/2018amna khairy abdul kareem 7
- 8. 9/27/2018amna khairy abdul kareem 8
- 9. 9/27/2018amna khairy abdul kareem 9
- 10. 9/27/2018amna khairy abdul kareem 10
- 11. 9/27/2018amna khairy abdul kareem 11
- 12. 9/27/2018amna khairy abdul kareem 12
- 13. 9/27/2018amna khairy abdul kareem 13
- 14. Study designs Level of evidence Grades of recommendtions. 9/27/2018amna khairy abdul kareem 14
- 15. 9/27/2018amna khairy abdul kareem 15 intervention observational Descriptive Case Report Case series Cross sectional analytical Case control Cohort Trials (RCT /Non RCT)
- 16. 9/27/2018amna khairy abdul kareem 16
- 17. Describes case characteristics May generate future ideas Useful for rare diseases and if disease is caused by single kind of exposure 9/27/2018amna khairy abdul kareem 17
- 18. Collects information about the current disease state or outcome and or exposure status 9/27/2018amna khairy abdul kareem 18
- 19. Identifying a group of subjects defined by their outcome, we look back in time to identify an exposure of interest. The aim is to identify risk factors of disease 9/27/2018amna khairy abdul kareem 19
- 20. 9/27/2018amna khairy abdul kareem 20
- 21. Identifying a group of subjects defined by their exposure status, being followed up over time to identify an outcome of interest. The aim is to determine whether an exposure status influences risk of disease 9/27/2018amna khairy abdul kareem 21
- 22. 9/27/2018amna khairy abdul kareem 22
- 23. 9/27/2018amna khairy abdul kareem 23 intervention observational Descriptive Case Report Case series Cross sectional analytical Case control Cohort Trials (RCT /Non RCT)
- 24. 9/27/2018amna khairy abdul kareem 24
- 25. 9/27/2018amna khairy abdul kareem 25
- 26. Case Series/ Case reports Case-control studies Cohort studies Randomised control studies Systematic reviews Meta- analyse s 9/27/2018amna khairy abdul kareem 26
- 27. Is it always the case ? 9/27/2018amna khairy abdul kareem 27
- 28. 9/27/2018amna khairy abdul kareem 28 PICO Question Prevalence / Etiology & risk factors Diagnosis: signs, symptoms or tests Prognosis Therapy Study Design Cross-sectional study Cohort study/ Case– control RCT or cross sectional Cohort study RCT
- 29. L1A • Systematic review of RCT L1B • Individual RCT (with appropriate power) L2A • Systematic review of cohort studies L2B • Individual cohort study , low quality RCT L3A • Systematic review of case-control studies L3B • Individual case-control study L 4 • Case-series (and poor quality cohort and case-control studies) L5 • Single case report, expert opinion " 9/27/2018https://www.uhms.org/1-randomized-controlled-trials.html 29
- 30. • consistent level 1 studies • consistent level 2 or 3 studies or extrapolations from level 1 studies • level 4 studies or extrapolations from level 2 or 3 studies level 5 evidence or troublingly inconsistent or inconclusive studies of any level 9/27/2018amna khairy abdul kareem 30
- 31. 9/27/2018amna khairy abdul kareem 31 Abstract Introduction Methodology Results Discussion and conclusion
- 32. 9/27/2018amna khairy abdul kareem 32 Abstract Relevance Methodology Validity Results Importance My patients +my setting Applicability
- 33. common problem outcome DOE(markers of the disease) vs. POEM(markers of health). Change the practice 9/27/2018amna khairy abdul kareem 33
- 34. 9/27/2018amna khairy abdul kareem 34 Relevance • personal knowledge Validity Importance • Results section Applicability • Personal Experience
- 35. 9/27/2018amna khairy abdul kareem 35 Therapy effectiveness Precision P value Confidence interval Magnitude NNT NNH
- 36. Diagnostic test Precision P value CI Clinical significance sensitivity specificity Likelihood ratio 9/27/2018amna khairy abdul kareem 36
- 37. 9/27/2018amna khairy abdul kareem 37 Relevance • personal knowledge Validity Importance • Results section Applicability • Personal Experience
- 38. Applicability System Preparedness: Availability, Cost etc Staff Preparedness: Knowledge, Skill etc Patient Factors & Acceptability: Similar to study population, Preferences, Values etc 9/27/2018amna khairy abdul kareem 38
- 39. https://www.ncbi.nlm.nih.gov/pubmedhealt h/PMH0078457/ . https://www.uhms.org/1-randomized- controlled-trials.html https://www.essentialevidenceplus.com/pro duct/ebm_loe.cfm?show=grade 9/27/2018amna khairy abdul kareem 39
- 40. Feel free to contact me amnakh22@gmail.co m +249924659036 Twitter: @amnakhairy 9/27/2018amna khairy abdul kareem 40
- 41. 9/27/2018amna khairy abdul kareem 41
- 42. 9/27/2018amna khairy abdul kareem 42
Editor's Notes
- The weird and wonderful, find examples , take screenshots
- Example! Last sentence.
- Example – examining the effect of nuclear radiation or environmental exposure
- Smokers, factory workers who are exposed to a certain chemical vs other factory workers not exposed, hazards of smoking in 35k doctors over 50 y
- Synthesised evidence we understand,
- https://www.uhms.org/1-randomized-controlled-trials.html
- Ep:lidocaine post MI
- Size =magnitude.