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EBM Therapy Appraisal Template F1

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An easy-to-use template and guide for Critical Appraisal

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EBM Therapy Appraisal Template F1

  1. 1. Journal Club: Critical Appraisal of an Article on Therapy Sudan Evidence-Based Medicine Association Template Developed by: Dr. Imad Salah Ahmed Hassan MD (UK) FACP FRCPI MemAcadMEd (UK) MSc (UK) MBBS (U of K)
  2. 2. Clinical Scenario
  3. 3. Formulate a Well-Built Clinical Question Patient Intervention Comparison Outcome
  4. 4. Outline your Search Strategy: Search Terms/Keywords/Mesh terms Search site/Search Engine Pubmed via PICO Pubmed Search Box & Limits Pubmed Clinical Queries Pubmed Advanced Search Cochrane Library Other
  5. 5. Outline Current Practice  Tip: From the Introduction Section or from a Guideline
  6. 6. Select a Reasonable Piece of Research Tip: Paste the title, authors, journal details here Type of Study:  RCT  Retrospective  Cohort  Case-Control  Other: Tip: Study Strength: RCT>cohort>case control>case series Date published: Number of Pages: Quality of journal i.e. impact factor (get from Google!) Linked-In: Author Details/Picture
  7. 7. Reason(s) for Selecting this Piece of Research  Tip: Common Reasons Answers my QUESTION Free article Recent Article Reputable Journal Other
  8. 8. Summarize the Results of your Article  Tip: Paste the Abstract/Conclusion from the Abstract here  Paste Abstract here: use several slides if it is long-remember the 6X6 rule in power-point presentations!
  9. 9. My Appraisal Map  Appropriateness of chosen Title?  Trustworthy Authors?  Truthful Abstract?  Comprehensiveness of Introduction section?  Relevance: Importance for Practice  Validity: Appropriate Methodology (Validity: Internal)?  Results: Trustworthy Results?  Applicability?  Impact of Findings on Current Practice and Future Recommendations?
  10. 10. Apply Your Appraisal Scheme  Tip: Use the RVRA Scheme: Based on the National & Gulf Center for Evidence-based Health Practice Relevance Validity Results Applicability
  11. 11. Apply Your Appraisal Scheme  Tip: Use the RVRA Scheme Relevance Personal Knowledge Validity Methods Section Results (Impact) Results Section Applicability Personal Interpretation/ Experience
  12. 12. Apply Your Appraisal Scheme Relevance Does the study address a common problem in your practice? Does the study address an important outcome to you or to your patient? (DOE vs. POEM) Assuming that the study conclusion is true; would it
  13. 13. Apply Your Appraisal Scheme Validity Describe the Research Design Tip:  Name the Study Design
  14. 14. Apply Your Appraisal Scheme Validity Describe the Selection Criteria, Interventions, Outcome Measures & Statistical Tests used Tip: From Method Section or Copy the Method Summary from the Abstract.  Copy the Inclusion & Exclusion Criteria  Copy the Study Flow Chart to your Presentation
  15. 15. Apply Your Appraisal Scheme Validity Copy the Inclusion & Exclusion Criteria Inclusion Criteria: Exclusion Criteria:
  16. 16. Apply Your Appraisal Scheme Validity Interventions
  17. 17. Apply Your Appraisal Scheme Validity Outcome Measures: Primary & Secondary Primary: Secondary:
  18. 18. Apply Your Appraisal Scheme Validity Statistical Tests (Appropriateness)
  19. 19. Apply Your Appraisal Scheme Validity Answer the following Questions: • Was the assignment of patients to treatment randomized? • Was the assignment concealed?  Method of Randomization: Describe  Selection bias: before intervention starts
  20. 20. Apply Your Appraisal Scheme Validity Were the groups similar at the start of the trial? Baseline prognostic factors (demographics, co- morbidity, disease severity, other known confounders) balanced? If different, were these adjusted for? Tip: Copy Table 1 (usually describes the different groups in the study).
  21. 21. Apply Your Appraisal Scheme Validity Were patients, their clinicians, and study personnel 'blind' to treatment? If NO  Was it possible  Can this induce bias  Levels of blinding: Open-label, Single, Double-blind, Triple-blind etc. Aside from the experimental intervention, were the groups treated equally? Performance bias:  Co-intervention  Contamination  Compliance
  22. 22. Validity Were all patients who entered the trial properly accounted for and attributed at its conclusion? (ITT & Follow-up) Intention-to-Treat ITT: Were patients analyzed in the groups to which they were randomized (intention to treat analysis)? Attrition Bias: Was follow-up complete & long enough? Sensitivity Analysis (WCS)
  23. 23. Validity * Were all clinically important outcomes considered? * Baseline characteristics (Prognostic Factors) influence on Outcomes?  Are substitute endpoints/surrogate tests valid?  Was the outcome assessor blind (Ascertainment/Detection bias or Measurement bias)  Clinical Outcomes  Quality of Life  Harm/Side-effects etc.
  24. 24. Validity Overall, is the method of the study valid? [ ] Yes (100%) [ ] No (0%) [ ] In-between ( ___%) [ ] Can't Tell
  25. 25. Apply Your Appraisal Scheme Results clinical significance (in MP : Magnitude & Precision) Magnitude of the effect: How large was the treatment effect & Specified Time Factor (Duration of Study)?  Risk difference (RD or ARR) Risk Ratio (RR) Relative risk reduction (RRR) NNT NNT for different outcomes NNH
  26. 26. Apply Your Appraisal Scheme Results clinical significance (in MP : Magnitude & Precision) Precision of the effect: How precise was the estimate of the treatment effect? Confidence intervals? Narrow or Wide Statistical vs. Clinical Significance
  27. 27. Summarize the Study Biases Selection, Attrition, Performance, Detection Biases, Conflict of Interest etc.
  28. 28. Summarize the Study Strength Tip: From the Discussion or Letter to the Editor/Editorial Comment etc. E.G.: Number of Patients, Randomization Method, Least Biases, Statistical Tests used, Outcome Measures, Ascertainment, Drop-outs, Length of Follow-up etc.
  29. 29. Summarize the Study Weaknesses Tip: From the Discussion or Letter to the Editor/Editorial Comment etc. E.G.: Number of Patients, Randomization Method, Least Biases, Statistical Tests used, Outcome Measures, Ascertainment, Drop-outs, Length of Follow-up etc.
  30. 30. Summarize the Study Tip: From the Discussion or Letter to the Editor/Editorial Comment etc.
  31. 31. Unanswered Questions from the Study Tip: From the Discussion or Letter to the Editor/Editorial Comment etc.
  32. 32. Apply Your Appraisal Scheme Applicability I (in IPPP: Intervention – Population - Preferences-Potential Benefits - Harm Can the results be applied to my patient care? 1. Can you do the Intervention exactly as it is described in the paper 2. Is your Patient similar to the population of the study? 3. Did you examine your patient’s Preferences? 4. Are the potential benefits outweigh the Availability-feasibility-cost-side effects Patients similar for demographics, severity, co-morbidity and other prognostic factors? (as per Inclusion & Exclusion Criteria) Compelling reason why the results should not be applied?
  33. 33. Applicability System Preparedness: Availability, Cost etc Staff Preparedness: Knowledge, Skill etc Patient Factors & Acceptability: Similar to study population, Preferences, Values etc
  34. 34. Resolution of your PICO Question Narrate/Write your PICO Question & Why is it important. Summarize the Study Findings Summarize the weaknesses, biases, NNT and NNH etc. Indicate the Level of Evidence & whether you are going to apply the findings to your patient: Which Implementation Tools you are going to Use: Education Pathways, Protocols, Order Set etc. System Redesign/Quality Improvement Team
  35. 35. Resolution of your PICO Question: Recommendations New Research: Is there a need to do more research of the subject? Y□ N □ Suggested research if the answer is yes: Audit: Is there a need to audit your practice? Y□ N □ Suggest an audit cycle. Publication: Is it worth publishing your Journal Club presentation in an EBM CAT journal or website? May be start your own JC website?
  36. 36. Useful Links  EBM Glossary of Terms: http://www.cebm.net/glossary/  EBM Calculators: http://ktclearinghouse.ca/cebm/practise/ca/calculators  EBM NNT, LR etc. Websites:  http://ktclearinghouse.ca/cebm/toolbox  http://www.thennt.com/  EBM Critical Appraisal Worksheets: http://ktclearinghouse.ca/cebm/practise/ca/worksheets  Diagnosis worksheet  Harm worksheet  Prognosis worksheet  Systematic review (of therapy) worksheet  Therapy worksheet

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