Professional Documents
Culture Documents
&
Critical Appraisal
Dr Richard de Ferrars
October 2009
Realistic Goals
What is realistic in 1 session?
What does EBM mean?
Why (and how) do we
read medical papers?
How to spot papers that
matter
Can you see through the statistics and spot the lies?
Why Bother?
There must be a better way than
being told what to do by
protocols & guidelines
Learning how to think for
yourself and develop skills in
critical appraisal
Learning how to link this in with
the care of your patients
Learning not to be a Lemming
(adjective)
Appraisal
(noun)
Big is Beautiful!
Big is Beautiful!
Who Says?
Strength of Recommendation:
1++ Meta-analysis of randomised controlled
trials.
1- Randomised controlled studies
2++ Systematic reviews of case-control &
cohort studies
2+/- Case-control studies & cohort studies
Non-analytical studies
(comparitive studies, case reports)
D Based on category or
extrapolated from category 2+
Who Says?
The hierarchy of studies is reasonably obvious
But the source of information is probably
equally important
Where do you go to get information, advice &
recommendations?
What sources & resources do you use?
Who Says?
Compromise between quality of information and
accessibility (ranked in quality order)
Your team
Your patients????
Accessibility
Under-researched groups
I Hate Statistics
Medical Statistics
Cannot escape it
You must have a basic
level of understanding
Tested in the AKT
Talking statistics with
patients may be
required in CSA
Taking Risks
The annual stroke risk in high risk AF:
Taking aspirin
12%
Taking warfarin6%
1.
2.
Taking Risks
Absolute risk (AR)
statement of how often the event happened
GP notebook (www.gpnotebook.co.uk)
an online encyclopaedia of medicine
Professional Reading
Browsing
Flicking the BMJ, BJGP, Pulse, GP
Has value, BUT restrict to 2-3 journals per week
Targeted Reading
Using the EBM resources to answer a particular
question
Critical Appraisal
How valuable is an interesting paper when (or if!) you
do come across one?
Critical Appraisal
Knowledge of EBM & statistics:
Knowing how believable the contents of
research & papers are.
Education
1-5 How likely to change your behaviour/ practice?
Applicability
1-5 How easy to apply & implement changes?
Discrimination
1-10 How good is the quality of the paper?
Evaluation
4-25 Total the score
Reaction
4-15
16-20
21+
Forget it
Think about it
Do it
Using READER
Practice using the READER model to
critically appraise journal articles
The End