How To Do Critical Appraisal of Any Research Article

In both biomedical research and medical academia, research publications serve a critical role. There are a huge number of research publications published all around the world. However, only a small percentage of them are good and have any research or academic worth. So, properly evaluating published publica-tions has become vital in this circumstance. This article is intended with medical graduates and post-graduates in mind, in order to clarify them how to critically evaluate research publications. It may also be used to write published research articles in an indirect way. A collection of questions is supplied to cover all aspects of a published research paper. To assess the quality of an article, a score system based on the following questions can be established.

Critical appraisal

@#Critical appraisal is the process of reading published research to make a judgement on its scientific value (validity), and to consider how its results can be applied in family and community practice (applicability). There are four main elements of critical appraisal in EBFP i.e., relevance, validity, results, and applicability. Some family practitioners are not so comfortable with appraisal because of their poor background in research. But we developed the guide questions for critical appraisal simple and provide advice on what and where to look for it in the published evidence.

Qualidade metodológica das avaliações econômicas de antineoplásicos submetidas à Agência Nacional de Saúde Suplementar (ANS) na atualização do rol 2020 ­ Estudo de avaliação crítica / Methodological quality of economic assessments of antineoplastics submitted to Supplementary Health Agency in the update of the 2020 list ­ Critical assessment study

Objetivo: Descrever e analisar criticamente as avaliações econômicas de medicamentos antineoplásicos submetidas à Agência Nacional de Saúde Suplementar (ANS) durante o processo de atualização do rol de procedimentos em saúde 2020. Métodos: Estudo transversal de análise crítica dos estudos de avaliação econômica integrantes da documentação submetida à ANS com o objetivo de incorporação no rol de procedimentos. A avaliação da qualidade metodológica foi realizada por meio da ferramenta Methodology Checklist 6: Economic Evaluations Version 3.0 da Scottish Intercollegiate Guidelines Network. Resultados: Foram incluídas 49 avaliações econômicas: 22 estudos de custo-efetividade, 10 estudos de custo-utilidade, três estudos de custo-minimização e 14 estudos de custo-efetividade e custo-utilidade. A qualidade metodológica foi considerada, na maior parte (88%), como aceitável ou de baixa qualidade. Conclusão: Estudos de avaliação econômica são fundamentais no processo decisório de incorporação de tecnologias na saúde suplementar. Esta análise crítica sugere que a qualidade dos estudos econômicos apresentados dentro das propostas de incorporação de antineoplásicos durante o processo de atualização do rol 2020 da ANS foi limitada. Inconsistências metodológicas e falta de um relato transparente reduzem a validade e a aplicabilidade dos achados na tomada de decisão.

Objective: To describe and critically appraise the economic evaluations of antineoplastic drugs submitted to the ANS during the process of updating its 2020' list of procedures. Methods: Cross-sectional study of critical analysis of the economic evaluation studies included in the documentation submitted to the ANS with the aim of incorporating them into the list of procedures. The methodological quality assessment was carried out using the Methodology Checklist 6: Economic Evaluations Version 3.0 of the Scottish Intercollegiate Guidelines Network. Results: Overall, 49 economic evaluations were included: 22 cost-effectiveness studies, 10 cost-utility studies, three cost-minimization studies and 14 mixed economic studies. Methodological quality was mostly considered as acceptable or low quality. Conclusion: Economic evaluation studies are fundamental in the decision-making process of incorporating technologies into supplementary health care. This critical appraisal suggests that the quality of the economic studies presented within the proposals to incorporate antineoplastics during the process of updating the ANS 2020 roll was limited. Methodological inconsistencies and lack of transparent reporting reduce the validity and applicability of findings for decision-making

Tumor check through teledermatology: A critical appraisal

@#Original article: Kroemer S, Frühauf J, Campbell T, Massone C, Schwantzer G, Soyer H, Hofmann-Wellenhof R. Mobile teledermatology for skin tumour screening: diagnostic accuracy of clinical and dermoscopic image tele-evaluation using cellular phones. Br J Dermatol. 2011;164(5):973-979. Aim: The original article aimed to evaluate the diagnostic accuracy of clinical and dermoscopic image tele-evaluation for mobile skin tumor screening. Setting and population: The tumors examined in the study were selected prospectively from an outpatient clinic in Graz, Austria in a duration of 3 months. They are from men or women with benign and/or malignant skin tumors of either melanocytic or non-melanocytic origin. A total of 104 tumors from 80 patients using a mobile phone camera were gathered. The lesions were from the head and neck area, trunk, legs and feet and genital area. Study examination: A board-certified dermatologist with clinical expertise in teledermatology and dermoscopy reviewed the clinical and dermoscopic pictures with clinical information separately. The results from the review of the pictures were compared with those obtained by face-to-face examination and the gold standard face-to-face examination plus histopathology. Outcome: Tumors were classified under four categories: benign non-melanocytic, benign melanocytic, malignant non-melanocytic and malignant melanocytic. The table (Table 1) below shows the final diagnoses of the skin tumors examined per category. Results: Among these 104 lesions, 25 (24%) benign non-melanocytic, 15 (14%) benign melanocytic, 58 (56%) malignant non-melanocytic and six (6%) malignant melanocytic lesions were identified. Clinical and dermoscopic tele-evaluations showed high sensitivity and specificity. For malignant non-melanocytic tumors, sensitivity for both clinical and dermoscopic lesions is 97%; specificity for clinical and dermoscopic lesions are 91& and 94%, respectively. For classifying malignant melanocytic lesions, sensitivity for both clinical and dermoscopic lesions is 100% while specificity is 98% and 97%, respectively Conclusion: Clinical image tele-evaluation might be the method of choice for mobile tumor screening. Both clinical image tele-evaluation and teledermoscopy achieved excellent and equally high concordance rates with the gold standard.

A Survey Showing the Need to Incorporate the Teaching of Critical Appraisal Skills in the Undergraduate Medical Curriculum.

Aim: Evidence based medicine (EBM) not only increases knowledge but forms the foundations upon which decision making processes are used in medicine. This requires well-conducted research and the ability for doctors to critically appraise literature. The aim of this survey was to gain an insight into the understanding of critical appraisal amongst medical student and trainees, with particular emphasis on the teaching aspect of these skills in the undergraduate curriculum. Methods: Online questionnaires were distributed within the West Midlands Deanery to final year medical students (from the three medical schools) foundation doctors, core surgical trainees and specialist registrars. The questions asked related to levels of confidence in critical appraisal of scientific papers, undergraduate exposure to the process of critical review and opinions on whether these skills should form a more significant component of the undergraduate curriculum. Results: 266 questionnaire responses were received from a range of grades. 127 final year medical students, 62 foundation doctors, 34 core trainees and 43 registrars. Respondents were asked to grade their confidence in critically appraising scientific papers from a choice of no confidence, little confidence, quite confident and very confident. There was a noticeable correlation between level of confidence and grade of respondent. 93% felt critical appraisal teaching was inadequate, with particular emphasis on research methods and paper analysis, with 96% of respondents suggesting this should form a mandatory part of the curriculum. Conclusion: This survey clearly demonstrates the need to ensure that critical appraisal skills are incorporated into the undergraduate curriculum so that newly qualified doctors begin their careers equipped with the essential skills required to practice evidence-based medicine.

Análisis crítico de la literatura: un proceso elemental en el ejercicio de la práctica clínica basada en la evidencia / Critical analysis of literature: a basic process in exercising evidence based clinical practice

Para realizar una práctica clínica basada en la evidencia (PCBE), se requiere adquirir una serie de habilidades; entre ellas la búsqueda de literatura en forma sistemática y eficiente y la aplicación de reglas formales para la evaluación de la literatura encontrada. De este modo, se logra obtener de forma precisa la mejor evidencia disponible. Es así como, se podría resumir que el proceso de PCBE incluye varios pasos, uno de los cuales es el análisis crítico de la evidencia encontrada en la búsqueda de la literatura. Es fundamental comprender que no toda la información proveniente de revistas científicas es confiable o verdadera y por ende adecuada para ser instaurada como guía para la práctica clínica. Por tal razón, la información debe ser analizada de forma crítica; es decir, examinar cuidadosa y sistemáticamente la investigación para juzgar su validez y confiabilidad; o dicho de otra forma, su valor y relevancia en un contexto particular. El objetivo de este artículo fue jerarquizar la información existente respecto de estrategias para realizar un análisis crítico de la literatura científica y describir las herramientas más utilizadas con este fin.

To carry out clinical practice based on evidence (CPBE), it is necessary to acquire some skills, including systematic literature search and application of formal rules for evaluation of the literature found, thereby obtaining the best evidence available. Thus, one could summarize the CPBE process includes several steps, one of which is critical appraisal of the evidence found in literature search. It is essential to understand that not all the information from scientific journals is reliable or valid, and therefore suitable to be instituted in clinical practice. For this reason, the information must be critically analyzed; i.e. carefully and systematically examining research to judge its validity and reliability, or stated another way, its value and relevance in a particular context. The aim of this article is to hierarchy the existing information on strategies to realize critical analysis of the scientific literature and to describe the tools most commonly used for this purpose.

Análisis crítico de guía clínica GES gran quemado versión 2007 / Critical appraisal of clinical guideline

Objective: Critical appraisal of the clinical practice guideline (CPG) "Gran Quemado-Extensive Burn Patients"(2007 issue) corresponding to "Garantías Explícitas en Salud- Explicit Health Guarantees" (GES). Material and Methods: The CPG was evaluated using the previously validated AGREE instrument. This instrument evaluates a series of items organized in 6 domains, that capture different dimensions of the guidelines quality comparing the scores obtained with a maximum theoretical score. The CPG was evaluated by three independent and masked authors applying the AGREE instrument. Results: Stratified by domain, in the "scope and purpose" domain there was an 88.9 percent of compliance; in "stakeholder involvement" 47.9 percent; in the "rigour of development" 47.6 percent; in "clarity and presentation" 79.2 percent; in "applicability" 30.6 percent and 75 percent in the "editorial independence" domain; reaching a 44.9 percent final score of compliance. Conclusions: The score obtained was below 50 percent of the optimum for a CPG. The detailed analysis by domain makes evident the areas that may be subject of improvement, so as to optimize the applicability of the CPG and therefore guarantee better health care and treatment results for all burn patients benefiting from the "Explicit Health Guarantees".

Objetivo: Evaluar críticamente la guía de práctica clínica (GPC) de Gran Quemado correspondiente a las Garantías Explícitas en Salud (GES) versión 2007. Material y Método: La evaluación se realizó con el instrumento AGREE el cual ha sido previamente validado. El instrumento AGREE evalúa una serie de ítems en 6 dominios entregando un puntaje específico que se compara con un máximo teórico. Tres autores en forma independiente y enmascarada evaluaron la GPC y puntuaron de acuerdo al instrumento utilizado. Resultados: Estratificando por dominio, en "alcance y objetivo" se obtuvo un 88,9 por ciento de cumplimiento; en participación de los implicados 47,9 por ciento; en rigor en la elaboración 47,6 por ciento; en claridad y presentación 79,2 por ciento; en aplicabilidad 30,6 por ciento y 75 por ciento en independencia editorial; entregando un puntaje final de 44,9 por ciento de cumplimiento. Conclusiones: El puntaje obtenido fue menor al 50 por ciento del óptimo para una GPC. El análisis detallado por dominio entrega en forma detallada las áreas susceptibles de perfeccionar para optimizar la aplicabilidad de la guía clínica y de tal forma garantizar la mejoría en el cuidado y los resultados del tratamiento de los pacientes quemados beneficiarios de las Garantías Explícitas en Salud.

Evidence-based approach to glaucoma management.

Evidence-based medicine is an evolving new paradigm. With the advent of numerous new diagnostic techniques and therapeutic interventions, one needs to critically evaluate and validate them by appropriate methods before adopting them into day-to-day patient care. The concepts involved in the evaluation of diagnostic tests and therapy are discussed. For delivering the highest level of clinical care, evidence alone is not sufficient. Integrating individual clinical experience and patients’ perspectives with the best available external evidence is essential.

A method to evaluate scientific evidence in clinical preventive medicine

Evaluation of scientific evidence in the medical literature is based on the research methodology, which can be the fundamental tool for medical professionals to improve their practice. Since analytic studies usually provide evidence for generating hypotheses and selecting appropriate research designs, this article aims to review the methods for evaluating the study quality in randomized controlled trials (RCTs), cohort studies, and case-control studies. Critical appraisal of systematic errors including selection bias, performance bias, attrition bias, detection bias, and publication bias are the essential elements of the evaluation. Clinical trials need to have an adequate description of sequence generation and allocation concealment, blinding for exposure measurement, completeness of follow-up and intention to treat analysis, and blinding for outcome evaluation. For cohort studies, like RCTs, appropriate control of confounding variables is needed to prevent selection bias, and blinding and completeness of follow-up are also very important. Matching of the case group to the control group, blinding of interviewers, and proper definition of the cases and controls are important to prevent bias in a case-control study. Since the process of critical appraisal depends on the quality of reporting, there have been efforts to improve the reporting quality of the medical literature. However, reporting all of the elements necessary to avoid bias does not automatically guarantee an exclusion of bias or the quality of a study; instead, what is important is the logical connection of the elements of a study and the eventual lucid expression of the elements.

Como avaliar criticamente revisões sistemáticas e metanálises? / How to critically assess systematic reviews and meta-analyses?

JUSTIFICATIVA E OBJETIVOS: Revisões sistemáticas são ferramentas importantes no fornecimento de evidências para tomada de decisão na prática da Terapia Intensiva. O objetivo deste estudo foi descrever os elementos importantes na avaliação crítica das revisões sistemáticas existentes em Terapia Intensiva. CONTEÚDO: Na avaliação crítica da revisão sistemática, é necessário que o intensivista atente para a estruturação da questão a ser respondida, a estratégia de busca utilizada, os critérios de inclusão e a qualidade metodológica dos estudos incluídos, e como foram extraídos os dados levantados. Além disso, uma revisão sistemática relevante deve apresentar resultados consistentes (caso tenha sido realizada metanálise) ou a causa de heterogeneidade deve ter sido explorada, e os resultados devem ser aplicáveis no paciente crítico. CONCLUSÕES: Para o correto emprego da evidência científica disponível, é necessário que o intensivista avalie criticamente a qualidade dos dados apresentados nas revisões sistemáticas, selecionando as informações relevantes para o manuseio do paciente crítico.

BACKGROUND AND OBJECTIVES: Systematic reviews are important knowledge generating tools to help the decision making process in the Critical Care Unit. This narrative aims to describe the important elements used to critically appraise intensive care-related systematic reviews. CONTENTS: When critically assessing systematic reviews, one should pay particular attention to the importance and appropriateness of the research question, the search strategy, the inclusion criteria and methodological quality of the studies included, and the methods of data extraction. In addition, a relevant systematic review must have consistent data (in case of a meta-analysis) or the cause of the heterogeneity must have been adequately explored, and results must be applicable in critical patients. CONCLUSIONS: To apply correctly the available scientific evidence, one should critically assess data quality of systematic reviews, selecting the relevant information to manage the critically ill patient.

Postgraduate Education Through Evidence-Based Medicine: Short-Term Effects on Knowledge and Behavior / 医学教育

Objective: To investigate whether postgraduate education through evidence-based medicine can affect the knowledge and behavior of residents.<BR>Design: Self-controlled and externally controlled trial.<BR>Setting: University hospital.<BR>Participants: Fifteen residents specializing in family medicine.<BR>Intervention: Four 2-hour seminars and weekly evidence-based medicine-style journal club meetings.<BR>Main outcome measures: Scores from a test of knowledge of evidence-based medicine and the number of MEDLINE searches conducted each month.<BR>Results: All residents improved their knowledge of evidence-based medicine and conducted more MEDLINE searches each month than did other medical residents or residents of our department last year.<BR>Conclusion: Postgraduate education through evidence-based medicine is effective in improving residents' knowledge and behavior.

Critical Appraisal of Pharmacoeconomic Studies in Japan / 薬剤疫学

Objective : The economic aspect of pharmaceuticals is becoming a major issue of health care financing in Japan due to the high total volume of drug consumption. To consider the feasibility and usefulness of pharmacoeconomic (PE) studies in health policy making, we aimed to conduct a review of PE studies published in Japan.<BR>Methods : We collected original published PE studies conducted in Japan from 1985 to 1995, by retrieving through computer databases such as MEDLINE and JMEDICINE, as well as other methods. We then reviewed the papers according to a checklist developed by Drummond et al.<BR>Results : Fourteen articles were found to satisfy the inclusion criteria. The overall checklist compliance rate were 45.8%. All of the PE studies were based on randomized clinical trial. Most of the studies lacked some important elements of PE analysis, such as the identification of all important and relevant costs and consequences (14.3%) and the presentation of all issues of concern (7.1%). Furthermore, most models and assumptions used in the studies were considered by us to be unreliable and inappropriate.<BR>Discussion : The quality of PE studies conducted in Japan was not considered by us to be satisfactory and our analysis identified areas for improvement. Further improvement in this field is urgently needed and may be achieved through PE guideline development and the training of specialists.