Topic 6 CRITICAL APPRAISAL OF MEDICAL ARTICLES

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Topic 6CRITICAL APPRAISAL OF MEDICAL ARTICLES

• Jarmila Potomková
• Medical Librarian
• Jan Strojil
• Department of Pharmacology
• Palacky University Faculty of Medicine
• Olomouc, Czech Republic
• Updated February 2009
• potomkov_at_tunw.upol.cz

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CRITICAL APPRAISALIN GENERAL

• Technique, skill
• Increasing effectiveness of your reading
• Excluding poorly designed studies
• Helping decide
• which articles could influence your daily work
• which are unsuitable.

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Searching for Best EvidenceWell-built Questions
Clinical Question for Today

• Crohns Disease
• A Role of Psychotherapy

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Live Case ScenarioUniversity Hospital Olomouc
2007

• Case
• 16-year old boy, Crohns diasease diagnosed in
  the age of 13
• Hospitalized for relapse of disease
• In a series of interviews he disclosed
  pharmacologic treatment noncompliance

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Foreground Question PICO Format

• P/Patient, population, problem
• adolescent boy Crohns disease/relapse
• I/Intervention
• drug treatment
• C/Comparison
• druh treatment psychological therapy
• O/Outcome
• improved quality of life

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Background QuestionWhat is Crohns disease?

• Crohn's disease is a chronic inflammation of the
  intestinal wall that may affect any part of the
  digestive tract.
• In the past few decades, Crohn's disease has
  become more common worldwide.
• It is most common among populations living in
  northern climates in developed areas of the
  world.
• It occurs about equally in both sexes, often runs
  in families.
• Most people develop Crohn's disease before age
  35, usually between the ages of 15 and 25.
• Typical symptoms include chronic diarrhea (which
  sometimes is bloody), crampy abdominal pain,
  fever, loss of appetite, and weight loss.
• Although Crohn's disease has no known cure, many
  drugs help reduce inflammation and relieve
  symptoms. .
• Source Merck Manual Home Edition. Available
  from
• http//www.merckmanual.com

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Merck Manual Home Edition
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PubMed Search ConsolidationSearch Strategy

• Selection of search terms
• Keywords
• Phrases
• Synonyms
• Combination of search terms
• Boolean logic
• Application of limits
• Occurrence of search terms
• Title, Title/Abstract, All fields
• Types of articles
• Age groups
• Etc.

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Boolean logic

• AND Combines terms to limit your search as both
  concepts must be present in all retrieved
  articles
• Example Crohn AND psychotherapy
• OR Widens your search as either term can be
  present in all retrieved articles
• Example psychotherap OR psycholog OR counsel
  OR educat
• NOT Limits your search by excluding a concept as
  one term must be present and the second term must
  not be present
• Example Crohn NOT surgery

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Truncation

• PubMed finds all terms that begin with a given
  text string
• Example
• Crohn
• PubMed retrieves Crohn disease, Crohns disease
  ,,,,,,,,,

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Crohns disease a role of psychotherapySearch
terms

• Crohn(s) disease
• Psychotherapy
• Psychological therapy
• Counselling
• Patient education
• Psychosomatic

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Search Strategy Suggestions

• Step 1
• Crohn
• Limits Title
• Step 2
• psychotherap OR psycholog OR psychosomatic OR
  counsel OR educat
• Limits Title/Abstract
• Step 3
• Combine searches 1 AND 2
• Step 4
• Limits Type of article/Randomized
  controlled trial

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Combine Searches
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Combine Searches - Results
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Limits Type of Article Randomized Controlled
Trial
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Original ArticlesRandomized Controlled Trials
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PubMed Search Results

• All 145
• Reviews 24
• Traditional (narrative)
• Systematic Meta-analysis (pre-determined
  criteria of study inclusion)
• Randomized Controlled Trials 9

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Example of Randomized Controlled Trial

• Keller W. et al.
• Effect of psychotherapy and relaxation on the
  psychosocial and somatic course of Crohn's
  disease main results of the German Prospective
  Multicenter Psychotherapy Treatment study on
  Crohn's Disease.
• J Psychosom Res. 200456(6)687-96. J

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RCT for Critical Appraisal
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CASP Critical Appraisal Skills Programme
Appraisal Tools
http//www.phru.nhs.uk/Pages/PHD/CASP.htm
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CASPRCT Screening Questions
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Any Published Comments on Article?
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Commentary
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Professional Databases with
Critically Appraised Topics

• Clinical Evidence
• http//www.clinicalevidence.com (fee)
• Systematic reviews
• Question(s)
• Option(s)
• Grades of evidence
• Beneficial
• Likely beneficial
• Trade off between benefit and harm
• Unknown effectiveness
• Unlikely beneficial
• Etc.

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Clinical EvidenceInterventions Questions