Evidence Based Medicine & Critical Appraisal of Research PDF

Evidence based medicine and critical appraisal of research Jamal M. Salih MBChB, MRCP, MA England, College of Medicine/University of Sulaimani 01/11/2023 Prepared by Dr. Jamal M. Salih 1 Evidence based medicine (EBM) EBM components is "the conscientious, explicit and judicious use of current...

Evidence based medicine and critical appraisal of research Jamal M. Salih MBChB, MRCP, MA England, College of Medicine/University of Sulaimani 01/11/2023 Prepared by Dr. Jamal M. Salih 1 Evidence based medicine (EBM) EBM components is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of patients Practicing EBM lead to improved quality, improved patient satisfaction, and reduced costs. So patients can share in the decision-making. Patient’s concerns are taken into consideration to determine the appropriate treatment plan. 01/11/2023 Prepared by Dr. Jamal M. Salih 2 The devolution of evidence based medicine 01/11/2023 Prepared by Dr. Jamal M. Salih 3 Evidence based management It is a 5-step approach 1. Formulate an answerable question 2. Search for the best available evidence 3. Critically appraise the quality of the found evidence 4. 5. Integrate the evidence with managerial expertise and organizational concerns and apply Monitor and evaluate the results 01/11/2023 Prepared by Dr. Jamal M. Salih 4 What Is Critical Appraisal? A technique for judging the methodological quality of a study. Low, medium and quality paper Critical Appraisal Is Part of Evidence-Based Medicine 01/11/2023 Prepared by Dr. Jamal M. Salih 5 Why is critical appraisal Over 20,000 biomedical journals, a necessary skill for publishing 2 million articles a year! physicians? Most are of limited relevance and utility All studies have flaws You can’t always depend on a good review You need to become “critical’ readers 01/11/2023 Prepared by Dr. Jamal M. Salih 6 Are studies consistent? Is it always easy to pick up robust information? Why inconsistency occurs? Why the study outcomes are not implemented? 01/11/2023 Prepared by Dr. Jamal M. Salih 7 Why clinical trial outcomes fail to translate into benefits for patients? 01/11/2023 Prepared by Dr. Jamal M. Salih 8 How to Become a “Critical” Reader • Don’t accept everything an author says at face value • Pay special attention to the Methods section • Ask yourself questions (try to answer them) as you’re reading an article • Do the numbers add up? • Do terms like “random selection”, “double-blind”, accurately reflect what was done? 01/11/2023 Prepared by Dr. Jamal M. Salih 9 PICO-T (Population, Intervention, Comparison, Outcome) frame • Therapy • In ___[P]___, do/does ___[I]___ result in ___[O]____ when compared with ___[C]___ over ___[T]____? • E.g.) In nursing home residents with osteoporosis, do hip protectors result in fewer injuries from falls when compared with standard osteoporosis drug therapy over the course of their stay? • Diagnosis • Is/are ___[I]___ performed on ___[P]___ more effective than ___[C]___ over ___[T]____in ___[O]____? • E.g.) Are self-reporting interviews and parent reports performed on children aged 510 more effective than parent reports alone over a four-week consultation process in diagnosing depression? 01/11/2023 Prepared by Dr. Jamal M. Salih 10 Critical Appraisal Involves 3 Stages UNDERSTAND the article:  What was the question?  What methods were used?  What did the authors find? Determine its VALIDITY: Were the study methods sound? Determine its UTILITY: How useful (i.e., generalizable) are the findings to your practice and patients? 01/11/2023 Prepared by Dr. Jamal M. Salih 11 Where to search? • Health Literature Databases  Medline: PubMed, OVID Medline  CINAHL  EMBASE • Grey Literature  Commissioned reports, government reports, dissertations, theses • Google Scholar 01/11/2023 Prepared by Dr. Jamal M. Salih 12 Structure of an article 1. Title 2. Abstract 3. Introduction 4. Background / review of literature 5. Methodology 6. Results 7. Discussion 01/11/2023 Prepared by Dr. Jamal M. Salih 13 Structure of an article 1.Title • Not always a good indication of the content of the article 2. Abstract Sometimes unclear. What should be in it? a summary of the research question, key methods, results and conclusions of the study 01/11/2023 Prepared by Dr. Jamal M. Salih 14 Structure of an article 3. Introduction: • Should contain the research question (PICOC!) or hypotheses tested 4. Background / review of literature • Research questions occur in the context of an already-formed body of knowledge. The background should address this context, help set the rationale for the study, and explain why the questions being asked are relevant 01/11/2023 Prepared by Dr. Jamal M. Salih 15 Structure of an article • 5. Methodology: Should describe exactly how the research was carried out - Sample: characteristics, selection, number, non-response - Measures: description of tests/questionnaires, data, outcome measures - Procedure: study design (qualitative, quantitative, controlled?) 01/11/2023 Prepared by Dr. Jamal M. Salih 16 Structure of an article 6. Results: • Should tell the reader what the findings were. All outcome measures must be reported and confidence intervals for effect sizes should be presented. 7. Discussion: -Interpretation of the results / relation to theory - Comparison with the results of other studies - Weaknesses / limitations of the study - Implications - Recommendations 01/11/2023 Prepared by Dr. Jamal M. Salih 17 Standard appraisal questions 1. Did the study address a clearly focused issue? 2. Is the sample size justified? 3. Is the design appropriate to the stated aims? 4. Are the measurements likely to be valid and reliable? 5. Are the statistical methods described? 6. Did untoward events occur during the study? 7. Were the basic data adequately described? 8. Do the numbers add-up? 9. Was the statistical significance assessed? 10. What do the findings mean? 11. Are important effects overlooked? 12. What implications does the study have for your practice? 01/11/2023 Prepared by Dr. Jamal M. Salih 18 Appraisal of a controlled study 1. Did the study address a clearly focused issue? 2. Were subjects randomly allocated to the experimental and control group? If not, could this have introduced bias? 3. Are objective inclusion / exclusion criteria used? 4. Were groups comparable at the start of the study? 5. Are objective and validated measurement methods used and were they similar in the different groups? (misclassification bias) 6. Were outcomes assessed blind? If not, could this have introduced bias? 7. Is the size of effect practically relevant? 8. Are the conclusions applicable? 01/11/2023 Prepared by Dr. Jamal M. Salih 19 Appraisal of a cohort / panel study 1. Did the study address a clearly focused issue? 2. Was the cohort / panel recruited in an acceptable way? (selection bias) 3. Was the cohort/ panel representative of a defined population? 4. Was a control group used? Should one have been used? 5. Are objective and validated measurement methods used and were they similar in the different groups? (misclassification bias) 6. Was the follow up of cases/subjects long enough? 7. Could there be confounding? 8. Is the size of effect practically relevant? 9. Are the conclusions applicable? 01/11/2023 Prepared by Dr. Jamal M. Salih 20 Appraisal of a case-control study 1. Did the study address a clearly focused issue? 2. Were the cases and controls defined precisely? 3. Was the selection of cases and controls based on external, objective and validated criteria? (selection bias) 4. Are objective and validated measurement methods used and were they similar in cases and controls? (misclassification bias) 5. Did the study incorporate blinding where feasible? (halo-effect) 6. Was there data-dredging? 7. Could there be confounding? 8. Is the size of effect practically relevant? 9. Are the conclusions applicable? 01/11/2023 Prepared by Dr. Jamal M. Salih 21 Assessment of a survey 1. Did the study address a clearly focused issue? 2. Was the sample size justified? 3. Could the way the sample was obtained introduce (selection)bias? 4. Is the sample representative and reliable? 5. Are the measurements (questionnaires) likely to be valid and reliable? 6. Was the statistical significance assessed? 7. Are important effects overlooked? 8. Can the results be generalized? 01/11/2023 Prepared by Dr. Jamal M. Salih 22 01/11/2023 Prepared by Dr. Jamal M. Salih 23 Summary 01/11/2023 Prepared by Dr. Jamal M. Salih 24 Thank you 01/11/2023 Prepared by Dr. Jamal M. Salih 25