Critically Appraising a Journal Article

Critically Appraising a Journal Article1What 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 action2What 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 relevanceWhat 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: Long-mans, 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 subscribeLinzer 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 questionSearching for evidence A critical appraisalCommentary and discussionSuccessful Journal Clubs include:A well constructed clinical questionAsking 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 questionSuccessful Journal Clubs include:A critical appraisalEvaluate the articles you have selectedYou may use the Critical Appraisal Worksheet

Benefits of Critical AppraisalAn 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 AppraisalThere 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 discussionIt 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 ArticleAbstractIntroductionMaterials and MethodsResultsDiscussionConclusion

Always Ask Six ThingsAs 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 Things1) What is the clinical question?2) Why was the question asked?3) What did they do? Methods4) 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 Things1) What is the clinical question?2) Why was the question asked?3) What did they do? Methods4) 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 Universitys Evidence Based Practice)

Diagnostic TestFor 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 DiagnosisDifferential Diagnosis involves the process of weighing the probability that one disease rather than another disease accounts for a patients illness.The Differential Diagnosis Study tries to sort out what proportion of the patients with a single sign or symptom has various diseases.Economic AnalysisAn economic analysis can provide accurate values to assess the cost of disease and the cost-benefit of interventions.

Harm / EtiologyA Harm/Etiology study addresses how to identify causes for disease (including iatrogenic forms ie caused by the healthcare system)PrognosticA prognostic study addresses how to estimate the patients likely clinical course over time and anticipate likely complications of disease. Practice GuidelineA 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 StudyA qualitative study deals with phenomena that are difficult or impossible to quantify mathematically, such as beliefs, meanings, attributes, and symbolsSystematic ReviewA 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.

TherapyA 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 QuestionAlways Ask Six Things1) What is the clinical question?2) Why was the question asked?3) What did they do? Methods4) 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 Things1) What is the clinical question?2) Why was the question asked?3) What did they do? Methods4) 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)BiasDeviation of results or inferences from the truth, or processes leading to such deviation.RecallSelectionCulturalConflict of InterestEconomicLead Time Length TimeTypes of StudiesThere are various types of studies for evaluating the answer to your questionTYPES OF STUDIES

ActivityStudents participate in a group activity.

Always Ask Six Things1) What is the clinical question?2) Why was the question asked?3) What did they do? Methods4) 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 ResultsAlways Ask Six Things1) What is the clinical question?2) Why was the question asked?3) What did they do? Methods4) 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 ConclusionAlways Ask Six Things1) What is the clinical question?2) Why was the question asked?3) What did they do? Methods4) 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 DiscussionAfter 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 CommentaryPubMedhttp://www.ncbi.nlm.nih.gov/pubmed/?otool=musmlibGoogle Scholarhttp://scholar.google.com.medlib-proxy.mercer.edu/ACP Journal Clubhttp://annals.org.medlib-proxy.mercer.edu/journalclub.aspxCochrane Journal Clubhttp://www.cochranejournalclub.com.medlib-proxy.mercer.edu/ Evidence Based Medicinehttp://ebm.bmj.com.medlib-proxy.mercer.edu/