The document outlines an agenda for a critical appraisal master class that will cover evidence-based medicine principles, critical appraisal of different study types including clinical studies, lab research, and qualitative work. It provides an introduction to the presenters and an outline of topics to be discussed including evidence-based medicine, critical appraisal keys of validity, applicability and impact. Case studies will also be used to demonstrate how to approach appraising a research paper.

1. Critical Appraisal Master class Tues 10th May

2. Critical Appraisal: WTF? (well that’s fab)

4. PhD Education Student

5. Journal Reviewer

6. Cochrane Author

8. MB ChB (nearly!)

9. Academic Foundation Post

10. RSM Rep

11. Massive geekYou?

12. Outline Evidence-based medicine Principles of critical appraisal Jargon busting Clinical studies Lab stuff Qualitative work

13. Evidence-Based Medicine What is it?

14. Structure of EBM

15. Critical Appraisal Should I believe this paper? Clinical Should I treat my patients differently based on this paper? Education Should we include this in the medical school curriculum? Lab Science Should we divert resources to investigate this further?

16. 3 Keys of Appraisal Validity Applicability Impact

17. Validity Validity: How far has this paper actually answered the question they set out to answer? Question: Does endovascular emergency AAA repair reduce mortality? Answer: Endovascular emergency AAA repair is associated with reduced blood loss.

18. Applicability Applicability Does the evidence from this paper apply to my patients? Trial Title Cleverstatin reduces cardiac events in male patients with type II diabetes. A randomized controlled trial Population 1000 patients in Helsinki, Finland Should I change my Wigan patients to the more expensive cleverstatin?

19. Impact Impact How much of a difference would this make? Trial Title High flow oxygen increases mortality in acute myocardial infarction. A randomised controlled trial. Recommendation Patients should no longer be given maximal oxygen therapy in acute MI. I am the SHO in A&E: a man presents with crushing chest pain – am I really going to withhold oxygen?

20. How to approach a paper!

21. Case Study

23. Impact factors

24. Conflict of Interests

25. Track Record

27. Is it an important question?

29. Methods

30. What kind of a study is it?

31. Expert opinion Thoughts of one person who has seen many cases

32. Case Reports/Series What happened with one patient? What happened with a few patients?

33. Case-control studies Risk Factors Time

34. Cohort studies Time

35. Confounding factors C Smoking Chewing Gum Lung Cancer A B

36. Randomized controlled trials (RCTs) ...Randomised… – minimisebias by randomly assigning subjects to groups ...Controlled… – compare your intervention to a control, where the only difference is the intervention …Trial… – you don’t know what’s going to happen

37. The Risk of Bias ‘Systematic differences between the two groups’ Selection bias Treatment bias Observer bias

39. Double blinding

40. Triple blinding

42. Intention to treat

43. Selective outcome reporting

44. Subgroup analyses

47. are the results meaningful – does it matter if the CRP is high if all the animals died?

48. good modeling – young animals do not represent aged obese smoking Salford residents

49. adequacy of controls – is that really the only difference

50. outcome assessment

51. are the controls normal

52. are the interventions different, how was this assessed

53. is there another explanation

54. how does it fit with existing research

56. Clear research questions – relevance to the real world?

57. Appropriate methodology - RCT in education

58. Clear recipe methods

59. Limitations and conclusionsBig problem So many qualitative methods, but 90% is description, very little is justification, even less clarification

60. Take home messages take nothing at face value healthy skepticism anyone can do it!

61. Further Reading Books: How to read a paper. Greenhalgh T. BMJ books. Blackwell publishing The doctors guide to critical appraisal. Gosall N, Gosall G. Pastest books Bad Science. Ben Goldacre Papers: Why Most Published Research Findings Are False. John Ioannidis Courses: Research methods and critical appraisal- www.rsm.ac.uk (events)