critical appraisal - core reading Flashcards
summarise finding evidence
there are a wide range of sources
need to be systematic to save time and make sure that you don’t miss out on important work
defining the question
clearly defined clinical/research question and some idea of which information source you will use
may have to modify search strategy after 1st review
searching for data
- use bibliographic database and enter terms
- use specific search terms eg MeSH
combine with Boolean operators - AND OR NOT
limit by year, language etc
refining the search
if too many - need to make results more focused
if too few you need to broaden the terms
look at qn to determine search terms and stategy
keeping records
need to do this so you can find them quickly in the future
Appraise
read papers to see if relevant, valid, applicable to patient
what should you do whne you have found relevant information
apply it in a clinical setting
why do you review
in a few years
see if the evidence has changed
reference databases
it is advisable to search 2 databases eg medline and embase because there kight be slightly different articles
ubmed - accesses many databases
citation data
citation - reference to another article/source of info
most influential articles have been cited the most
use the Citation Indicies
also in Google scholar
conference abstracts
Conference proceedings citation index - info that was first published at a conference
open access resources
publicly funded research is published in open access journals - so everyone can benefit
eg UK PubMed Central
evidence based medicine resources
if looking for specific answer should see if it is already reviewed by reputable group eg
Cochrane library - systematic reviews, clinical trials, health technology assessments, economic evaluations
BMJ clinical evidence - systematic reviews and links to other resources
TRIP database
bibliographic software
manage referenced info by storing it in personal database or library
what tasks does bibliographical software do?
- Manual cataloguing of bibliographic references relating to particular research areas/topics.
- Automated collection and organization of references from bibliographic databases, library catalogues, etc.
- Quick searches for a particular reference.
- Search and retrieval of bibliographic subsets.
- Print or save a list of references.
- Integration with word-processing software to automatically insert and format citations and bibliographies.
- Formatting of references according to particular bibliographic styles (e.g. Chicago, Harvard, individual journals’ styles) and also formats for exporting to other packages and for data-sharing.
- Find, import, and save full-text articles and access them from anywhere online.
what is critical appraisal
assess validity of research
decide how applicable it is to the question you’re trying to answer
validity
conclusions justified by methods and findings
reasonable assumptions
considered confounding
avoided selection bias
applicability
will the results help locally
are problems you’re dealing with similar enough to those in review that the results can be extrapolated
can you generalise from the results into clinical practice
Question
what is the question
how does it relate to previous studies
hypothesis
relevant, focused and carefully formulated
design
type of study
is that appropriate
where does the design fit into the hierarchy of evidence
population
which population
relevant to your population
generalisable
sample size - power
did they reach the numbers required
how were the patients recruited - all from population or a sample
response rate - did responders differ from non-responders - cause bias
inclusion criteria
need target population - otherwise only people interested in this area will respond
exclusion criteria - remove bias
controls - how were they defined, are they representative of the people w/o the disease
cases- defined and recruited
setting - real life? or at home
methods
what intervention was considered
which exposure considered with which outcome
what exposures and confounders were measured and how
any potential for bias
what was the outcome measured - blind, measurement same in both groups
follow up - is it long enough to detect the intervention, loss to follow up?
data management
appropriate
checked by double entry and cleaned
was storage secure and confidential, who had access
personal info disclosed?
any linkage describes, was it likely to miss links?
analysis
primary and secondary endpoints described in advance
explicit framework
statistical tests - eliminate chance findings, were they adequately described
confounders
were they measured and adjusted for
bias
Is there a systematic error in the study design, data collection/measurement procedures, analyses, reporting, or a combination of these factors that has led to conclusions that are systematically different from the truth?
completeness of follow up
was assessment blinded
ethics
Has the study been reviewed and approved by an independent Ethics Committee or Institutional Review Board (IRB)?
consent
any obvious ethical challenges
patient engagement
Were any patients consulted or involved in any way in the design, management, analysis, or interpretation of the study?
interpretation
appropriate
other interpretations
appropriate with other research findings
Bradford hill criterea
applicibility
can you generalise
Equaror network website
appraisal checklists are regularly reviewed, updated, and new ones added.
what design is appraised by CONSORT
RCT
what design is appraised by MOOSE
meta analysis for observational studies
what design is appraised by PRIMSA
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
what design is appraised by STARD
diagnositic test accuracy studies
what design is appraised by STREGA
strengthening the reporting of genetic associations
what design is appraised by STROBE
observational studies
