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Topic 6 CRITICAL APPRAISAL OF MEDICAL ARTICLES

Topic 6 CRITICAL 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@tunw.upol.cz. CRITICAL APPRAISAL IN GENERAL. Technique, skill

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Topic 6 CRITICAL APPRAISAL OF MEDICAL ARTICLES

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  1. 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@tunw.upol.cz

  2. 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.

  3. Searching for Best Evidence„Well-built Questions“ Clinical Question for Today: Crohn´s Disease: A Role of Psychotherapy

  4. Live Case ScenarioUniversity Hospital Olomouc : 2007 • Case • 16-year old boy, Crohn´s diasease diagnosed in the age of 13; • Hospitalized for relapse of disease; • In a series of interviews he disclosed pharmacologic treatment noncompliance

  5. Foreground Question: PICO Format • P/Patient, population, problem adolescent boy; Crohn´s disease/relapse • I/Intervention drug treatment • C/Comparison druh treatment + psychological therapy • O/Outcome improved quality of life

  6. Background QuestionWhat is Crohn´s 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

  7. Merck Manual – Home Edition

  8. 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.

  9. 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*NOTsurgery

  10. Truncation * • PubMed finds all terms that begin with a given text string • Example • Crohn* • PubMed retrieves: Crohn disease, Crohn´s disease ,,,,,,,,,

  11. Crohn´s disease : a role of psychotherapySearch terms Crohn(´s) disease • Psychotherapy • Psychological therapy • Counselling • Patient education • Psychosomatic

  12. 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

  13. Combine Searches

  14. Combine Searches - Results

  15. Limits: Type of Article: Randomized Controlled Trial

  16. Original ArticlesRandomized Controlled Trials

  17. PubMed Search Results • All: 145 • Reviews: 24 • Traditional („narrative“) • Systematic + Meta-analysis (pre-determined criteria of study inclusion) • Randomized Controlled Trials: 9

  18. 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. 2004;56(6):687-96. J

  19. RCT for Critical Appraisal

  20. CASP – Critical Appraisal Skills Programme: Appraisal Tools http://www.phru.nhs.uk/Pages/PHD/CASP.htm

  21. CASPRCT – Screening Questions

  22. Any Published Comments on Article?

  23. Commentary

  24. 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.

  25. Clinical EvidenceInterventions: Questions

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