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CRITICAL APPRAISAL OF THE MEDICAL LITERATURE

CRITICAL APPRAISAL OF THE MEDICAL LITERATURE. Hurley Research Center. BACKGROUND. 1992 JAMA Evidence-Based Medicine: A New Paradigm . . . by the McMaster University Evidence-Based Medicine Working Group in Hamilton, Ontario. 1993 JAMA User’s Guide to the Medical Literature I

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CRITICAL APPRAISAL OF THE MEDICAL LITERATURE

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  1. CRITICAL APPRAISAL OF THE MEDICAL LITERATURE Hurley Research Center

  2. BACKGROUND • 1992 JAMA Evidence-Based Medicine: A New Paradigm . . . by the McMaster University Evidence-Based Medicine Working Group in Hamilton, Ontario. • 1993 JAMA User’s Guide to the Medical Literature I through XIII published in 1997.

  3. Evidence-Based Medicine An approach to clinical decision-making in which one searches the literature, critically evaluates the research evidence, and then chooses the most appropriate intervention or course of action to take.

  4. Critical Appraisal of Literature Intended to enhance the clinician’s skill to determine whether the results reported in an article were likely to be . . . . . . . true . . . important . . . applicable to their patients!

  5. KEY QUALITY PARAMETERS • VALIDITY • RELIABILITY • IMPORTANCE

  6. VALIDITY • INTERNAL Is the study designed in such a way that I can trust the findings? • EXTERNAL Is the study designed in such a way that I can generalize the findings?

  7. RELIABILITY If the study was conducted again, would the results be the same? Usually interpreted as the accuracy of measurement.

  8. IMPORTANCE What was the effect size or magnitude of effect? Clinical vs. statistical significance.

  9. Tools for Critical Appraisal • What are the results? • Are the results valid? • Will the results help me in patient care? EBM “simplified” approach:

  10. COMMON PROBLEMS INTRODUCTION • In concise statement of the problem • Inadequate review of the literature • Weak study rationale

  11. COMMON PROBLEMS METHODS • Inadequate sample size, non-representative sample, or biases in subject selection or recruitment • Inadequate controls (random assignment, or well-matched controls?) • Measurement biases (valid tools? blinded? timing appropriate? follow-up?)

  12. COMMON PROBLEMS • Selection and/or number of statistical tests performed • Selection of variables for inclusion RESULTS

  13. COMMON PROBLEMS • Failure to link findings to current literature • Inappropriate inferences • Failure to critique own work • Little insight or direction provided DISCUSSION

  14. APPLICATION TO PRACTICE • Increase patient trust • Provide best possible care • Reduce liability risk

  15. EXERCISE

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