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Transcript of Critical Appraisal
to assess its validity (closeness to the truth)
and usefulness (clinical applicability)"
(After Sackett and Hayes, EBM 1995 1, 4-5.) Why is it important? How is appraisal done? And its not just the medical literature .... Problem/scenario
Determine appropriate sources
Identify relevant article
Use an appropriate tool or checklist
Assess relative merits/demerits
Make an overall assessment
Apply findings where possible The mass media is often our first level of exposure to the medical literature
- The internet (news sites, social media)
- Radio More research is published than we can ever hope to read
In 2012 over 14000 RCT's were published in Medline alone
Research is of variable quality
Only 1% is judged to be clinically relevant
Where is the 1%? Bad news is good news...
Bad health news sells papers
Negative effects of healthcare interventions are the most popular
You may remember:
- MMR (vaccination rates)
- HRT and cancer/heart disease (stopping medication)
Contraceptive Pill and DVT (pregnancy rates)
Originate from journal articles, conferences and press releases etc. Patients are more likely than ever to question health professionals' decisions so you need:
The ability to track down the source publication
Critical appraisal skills to assess the quality of the original evidence Where do we use critical appraisal?
Undergraduate and postgraduate education
Health Technology Assessment
Production of guidelines
In certain databases e.g. DARE, NHS EED
Current awareness bulletins/journals e.g. Bandolier Why should I get involved?
Makes your practice more 'evidence based'
Improves patient care
Is now an essential skill for users of research
Its fun* *(if you like that sort of thing...) Resources to support critical appraisal... There are 3 major players... CASP or Critical Appraisal Skills Programme
http://www.casp-uk.net CEBM or Centre for Evidence Based Medicine
http://www.cebm.net Centre for Health Evidence
User Guides to the Medical Literature
http://www.cche.net Reccommended Book http://www.bmj.com/about-bmj/resources-readers/publications/how-read-paper Critical Appraisal of a Single Study...
There are three broad issues to consider
A, What are the results?
B, Are the results valid? (internal validity)
C, Are the results relevant to the local setting (external validity) Getting Started Scenario:
from real life or invented Article:
primary or secondary study addressing the problem in hand Checklist:
for assessing the study design of the article Let's do it! knowledgeable of research design in quantitative researchable to evaluate the quality of published quantitative research specifically randomised controlled trials and systematic reviews This session will make you: What is a systematic review?
What is critical appraisal?
Two appraisal workshops Today's Agenda - a general term for all attempts to synthesise the results and conclusions of two or more publications on a given topic
(Clancy, M.J. (2002) Overview of research designs EMJ 19: 546-549) A review of a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant research, and to collect and analyse data from the studies that are included in the review.Statistical methods (meta-analysis) may or may not be used to analyse and summarise the results of the included studies.(The Cochrane Collaboration, (n.d.) Cochrane Glossary [online] Available from: http://www.cochrane.org/glossary/5 [12 January 2011] ) Review Systematic Reviews? Why do systematic reviews?