critical appraisal - core reading

Question 1

summarise finding evidence

Answer 1

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

Question 2

defining the question

Answer 2

clearly defined clinical/research question and some idea of which information source you will use
may have to modify search strategy after 1st review

Question 3

searching for data

Answer 3

• use bibliographic database and enter terms
• use specific search terms eg MeSH
  combine with Boolean operators - AND OR NOT
  limit by year, language etc

Question 4

refining the search

Answer 4

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

Question 5

keeping records

Answer 5

need to do this so you can find them quickly in the future

Question 6

Appraise

Answer 6

read papers to see if relevant, valid, applicable to patient

Question 7

what should you do whne you have found relevant information

Answer 7

apply it in a clinical setting

Question 8

why do you review

Answer 8

in a few years

see if the evidence has changed

Question 9

reference databases

Answer 9

it is advisable to search 2 databases eg medline and embase because there kight be slightly different articles
ubmed - accesses many databases

Question 10

citation data

Answer 10

citation - reference to another article/source of info
most influential articles have been cited the most
use the Citation Indicies
also in Google scholar

Question 11

conference abstracts

Answer 11

Conference proceedings citation index - info that was first published at a conference

Question 12

open access resources

Answer 12

publicly funded research is published in open access journals - so everyone can benefit
eg UK PubMed Central

Question 13

evidence based medicine resources

Answer 13

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

Question 14

bibliographic software

Answer 14

manage referenced info by storing it in personal database or library

Question 15

what tasks does bibliographical software do?

Answer 15

• 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.

Question 16

what is critical appraisal

Answer 16

assess validity of research

decide how applicable it is to the question you’re trying to answer

Question 17

validity

Answer 17

conclusions justified by methods and findings
reasonable assumptions
considered confounding
avoided selection bias

Question 18

applicability

Answer 18

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 19

Question

Answer 19

what is the question
how does it relate to previous studies
hypothesis
relevant, focused and carefully formulated

Question 20

design

Answer 20

type of study
is that appropriate
where does the design fit into the hierarchy of evidence

Question 21

population

Answer 21

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

Question 22

methods

Answer 22

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?

Question 23

data management

Answer 23

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?

Question 24

analysis

Answer 24

primary and secondary endpoints described in advance
explicit framework
statistical tests - eliminate chance findings, were they adequately described

Question 25

confounders

Answer 25

were they measured and adjusted for

Question 26

bias

Answer 26

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

Question 27

ethics

Answer 27

Has the study been reviewed and approved by an independent Ethics Committee or Institutional Review Board (IRB)?
consent
any obvious ethical challenges

Question 28

patient engagement

Answer 28

Were any patients consulted or involved in any way in the design, management, analysis, or interpretation of the study?

Question 29

interpretation

Answer 29

appropriate
other interpretations
appropriate with other research findings
Bradford hill criterea

Question 30

applicibility

Answer 30

can you generalise

Question 31

Equaror network website

Answer 31

appraisal checklists are regularly reviewed, updated, and new ones added.

Question 32

what design is appraised by CONSORT

Answer 32

RCT

Question 33

what design is appraised by MOOSE

Answer 33

meta analysis for observational studies

Question 34

what design is appraised by PRIMSA

Answer 34

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Question 35

what design is appraised by STARD

Answer 35

diagnositic test accuracy studies

Question 36

what design is appraised by STREGA

Answer 36

strengthening the reporting of genetic associations

Question 37

what design is appraised by STROBE

Answer 37

observational studies