Transcript Critically Appraising a Journal Article PowerPoint

What is a Journal Club?
 An educational meeting in which a group of
individuals read, evaluate and discuss current articles
from the biomedical literature
 A collective forum to provide a venue to keep up with
the literature
 One of the most effective means by which students
and professionals keep up with current biomedical
literature
 Evidence based practice in action
What is a Journal Club?
 Classic learning and information sharing format
 Focused on current literature
 “Just-in-time” delivery
 Critically appraised information with
commentary
and discussion for applicability and relevance
What is a Journal Club?
 The earliest reference to a journal club is found in a
book of memoirs and letters by the late Sir James
Paget, a British surgeon and one of the founders of
modern pathology. He describes a group at St.
Bartholomew's Hospital in London in the mid-1800s
with 'a kind of club ... a small room over a baker's shop
near the Hospital-gate where we could sit and read the
journals.‘
Paget S: Memoirs and Letter of Sir James Paget. London: Longmans, Green, and Co., 1901:42
What is a Journal Club?
 It is believed that Sir William Osler established the
first formal journal club at McGill University in
Montreal in 1875, though Osler himself might have
been aware of similar gatherings that were taking place
elsewhere. The purpose of Osler's early journal club
was 'for the purchase and distribution of periodicals to
which he could ill afford to subscribe‘
Linzer M: The journal club and medical education: over one
hundred years of unrecorded history. Postgrad Med J
1987,63:475-478.
Successful Journal Clubs include:
 A well constructed clinical question
 Searching for evidence
 A critical appraisal
 Commentary and discussion
Successful Journal Clubs include:
 A well constructed clinical question
 Asking a “well-built clinical question” will facilitate
your search for and acquisition of the answer.
 The clinical question being investigated is asked in the
PICO format (Patient/population, intervention,
comparison, outcome) More to come!
Successful Journal Clubs include:
 Searching for evidence
 Search for articles using your well-built question.
 Identify what type of question you are asking (therapy,
prevention, cost-analysis, etc) and what type of studies
(RCT, cohort, case reports) are best for evaluating the
answer to your question
Successful Journal Clubs include:
 A critical appraisal
 Evaluate the articles you have selected
 You may use the Critical Appraisal Worksheet
Benefits of Critical Appraisal
 An analytical summary and evaluation of a research
study
 Standard approach: recognize important information
 Standard format: easily digested, a quick read
 Usable by professionals in busy practices as
summarized, synthesized evidence
Method of Appraisal
 There are a number of methods used to critically
appraise an article.
 They all have the same basic format.
 The method that we are using is based on one
developed by Duke University.
 It is a method that you will see in journal clubs in your
3rd year clerkships and in your residency program
encounters.
Successful Journal Clubs include:
 Commentary and discussion
 It is also helpful to look for any accompanying editorial
commentary, which can provide a unique perspective
on the article and highlight controversial issues.
Anatomy of a Scientific Article
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 Conclusion
Always Ask Six Things
 As you go through the anatomy of the article, you will
always ask six things that will correspond to the
various parts of the article.
Always Ask Six Things
 1) What is the clinical question?
 2) Why was the question asked?
 3) What did they do? Methods
 4) What was the answer ? Results
 5) What did they say about the answer? Conclusion
 6) What do I do with this information? Is this study of
significant enough quality in method to change my
practice one way or the other? - (Studies done
different ways mean different things) (Look at
commentary/discussion)
Always Ask Six Things
 1) What is the clinical question?
 2) Why was the question asked?
 3) What did they do? Methods
 4) What was the answer ? Results
 5) What did they say about the answer? Conclusion
 6) What do I do with this information? Is this study of
significant enough quality in method to change my
practice one way or the other? - (Studies done
different ways mean different things) (Look at
commentary/discussion)
1. What is the Clinical Question?
 What type of question is being asked in your article?
 This is typically found in the Introduction
 (See Critical Appraisal Checklist based on Duke
University’s Evidence Based Practice)
Diagnostic Test
 For clinicians to use a diagnostic test in clinical
practice, they need to know how well the test
distinguishes between those who have the suspected
disease or condition and those who do not.
 Diagnostic test studies evaluate a test for diagnosing a
disease.
Differential Diagnosis
 Differential Diagnosis involves the process of weighing
the probability that one disease rather than another
disease accounts for a patient’s illness.
 The Differential Diagnosis Study tries to sort out what
proportion of the patients with a single sign or
symptom has various diseases.
Economic Analysis
 An economic analysis can provide accurate values to
assess the cost of disease and the cost-benefit of
interventions.
Harm / Etiology
 A Harm/Etiology study addresses how to identify
causes for disease (including iatrogenic forms – ie
caused by the healthcare system)
Prognostic
 A prognostic study addresses how to estimate the
patient’s likely clinical course over time and anticipate
likely complications of disease.
Practice Guideline
 A practice guideline study is a systematically
developed statement on medical practice that assists a
practitioner and a patient in making decisions about
appropriate health care for specific medical
conditions.
Qualitative Study
 A qualitative study deals with phenomena that are
difficult or impossible to quantify mathematically,
such as beliefs, meanings, attributes, and symbols
Systematic Review
 A systematic review is a literature review focused on a single
question that tries to identify, appraise, select and synthesize all
high quality research evidence relevant to that question.
 A meta-analysis is a survey in which the results of all of the
included studies are similar enough statistically that the results are
combined and analyzed as if they were one study.
Therapy
 A therapy study addresses how to select treatments to
offer patients that do more good than harm and that
are worth the efforts and costs of using them.
Question!
 Students participate in PollEverywhere Question
Always Ask Six Things
 1) What is the clinical question?
 2) Why was the question asked?
 3) What did they do? Methods
 4) What was the answer ? Results
 5) What did they say about the answer? Conclusion
 6) What do I do with this information? Is this study of
significant enough quality in method to change my
practice one way or the other? - (Studies done
different ways mean different things) (Look at
commentary/discussion)
2. Why was the question asked?
 What did the author/s want to know?
 This is typically found in the Introduction
Always Ask Six Things
 1) What is the clinical question?
 2) Why was the question asked?
 3) What did they do? Methods
 4) What was the answer ? Results
 5) What did they say about the answer? Conclusion
 6) What do I do with this information? Is this study of
significant enough quality in method to change my
practice one way or the other? - (Studies done
different ways mean different things) (Look at
commentary/discussion)
3. What did they do? (Methods)
 You look for the validity of the study by checking the
way it was carried out.
3. What did they do? (Methods)
 Validity
 The degree to which the results of a study are likely to
be true, believable and free of bias.
3. What did they do? (Methods)
 Bias
 Deviation of results or inferences from the truth, or
processes leading to such deviation.
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Recall
Selection
Cultural
Conflict of Interest
Economic
Lead Time
Length Time
Types of Studies
 There are various types of studies for evaluating the
answer to your question
TYPES OF STUDIES
Activity
Students participate in a group activity.
Always Ask Six Things
 1) What is the clinical question?
 2) Why was the question asked?
 3) What did they do? Methods
 4) What was the answer ? Results
 5) What did they say about the answer? Conclusion
 6) What do I do with this information? Is this study of
significant enough quality in method to change my
practice one way or the other? - (Studies done
different ways mean different things) (Look at
commentary/discussion)
4. What was the answer? (Results)
 What was the consequence, effect, or outcome of the
study?
 This is found in the Results
Always Ask Six Things
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1) What is the clinical question?
2) Why was the question asked?
3) What did they do? Methods
4) What was the answer ? Results
5) What did they say about the answer?
Conclusion
 6) What do I do with this information? Is this study of
significant enough quality in method to change my
practice one way or the other? - (Studies done
different ways mean different things) (Look at
commentary/discussion)
5. What did they say about the
answer? Conclusion
 What was the decision reached?
 This is typically in the Conclusion
Always Ask Six Things
 1) What is the clinical question?
 2) Why was the question asked?
 3) What did they do? Methods
 4) What was the answer ? Results
 5) What did they say about the answer? Conclusion
 6) What do I do with this information? Is this study of
significant enough quality in method to change my
practice one way or the other? - (Studies done
different ways mean different things) (Look at
commentary/discussion)
6. What do I do with this
information?
 Is this study of significant enough quality in method to
change my practice one way or the other?
 Look at the commentary and discussion that has been
provided by the author/s in the journal article.
Commentary and Discussion
 After you have appraised the commentary/discussion
part of the article, your Journal Club will end with the
journal club participants engaging in commentary and
discussion about the article.
 It is also helpful to look for any accompanying editorial
commentary, which can provide a unique perspective
on the article and highlight controversial issues.
 Look up your article and see if there are any comments
affiliated with your article.
Where to find Commentary
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PubMed
http://www.ncbi.nlm.nih.gov/pubmed/?otool=musmlib
Google Scholar
http://scholar.google.com.medlib-proxy.mercer.edu/
ACP Journal Club
http://annals.org.medlibproxy.mercer.edu/journalclub.aspx
Cochrane Journal Club
http://www.cochranejournalclub.com.medlibproxy.mercer.edu/
Evidence Based Medicine
http://ebm.bmj.com.medlib-proxy.mercer.edu/