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How to use medical literature

Date post: 04-Dec-2014
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The use of medical literature, and assessment of the quality of research
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Dr Harshal Rajekar. HPB, GI and transplant Surgeon, Ruby Hall Clinic
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Page 1: How to use medical literature

Dr Harshal Rajekar.

HPB, GI and transplant Surgeon,

Ruby Hall Clinic

Page 2: How to use medical literature
Page 3: How to use medical literature

Intended to enhance the clinicians ability to determine whether a study done or new findings reported are…..1. likely to be true.2. important.3. applicable to their patients.

Page 4: How to use medical literature

How will it affect your day to day practice.

How will it benefit. Are practices going to change.

What’s in it for me?

Page 5: How to use medical literature

Review articles. Meta-analysis. Controversial topics- listen to both sides,

see what everyone has to say. Try to analyze new papers/ publications

on the nasis of the knowledge that you already have.

Page 6: How to use medical literature

Questions to ask of every paper you

are willing to read

Page 7: How to use medical literature
Page 8: How to use medical literature
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Page 10: How to use medical literature

I. Evidence obtained from at least one properly designed randomized controlled trial

Page 11: How to use medical literature

II.1 Evidence obtained from well designed controlled trials without randomization.

II.2 Evidence obtained from well designed cohort or case control studies, preferably from morethan one center.

Page 12: How to use medical literature

II.3 Evidence obtained from multiple time series with or without intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatments in the 1940s) could also be regarded as this type of evidence

Page 13: How to use medical literature

III. Opinions of respected authorities,based on clinical experience,descriptive studies, case reports,

or reports of expert committees

Page 14: How to use medical literature

Watch for cryptic titles. Sometimes useful publications ar hidden behind some very cryptic or confusing titles.

Do not reject or not read an article on the basis of title alone.

Page 15: How to use medical literature

Should I Spend My Time Reading This Paper ?

States the Purpose of Article, Major Procedures and Methods, Main Findings, and Conclusions

More and More Journals are using Structured Abstracts

Page 16: How to use medical literature

Objectives

Study Design

Methods

Results

Conclusions

Page 17: How to use medical literature

If properly designed and analyzed, is this study, important and worth knowing about?

Page 18: How to use medical literature

If the results are statisticallysignificant, do they also have clinical significance? If the results are not statistically significant, was the sample size sufficiently large to detect a meaningful difference or effect?

Page 19: How to use medical literature

Why is this study needed ?

What is the purpose of this study?

Was purpose known before the study

or a chance finding discovered as part

of ‘data dredging?’

Page 20: How to use medical literature

What has been done before and how

does this study differ? (Places study

in proper context such as

inadequacies of earlier work or next

step in an overall research project)

May also be found in DISCUSSION

Page 21: How to use medical literature

Does the location of the study haveRelevance (TO ME)?

What is the population to which the study findings apply?

Page 22: How to use medical literature

Is the time period covered by the studyAppropriate (TO ME). Long studies may have informative censoring.

Short studies may not have adequate follow-up time.

Page 23: How to use medical literature

A snap-shot in time for the study population

Was the sample selected in an appropriate manner (random, convenience, etc)?

Page 24: How to use medical literature

Were efforts made to ensure a good response rate or to minimize the occurrence of missing data?

Were reliability (reproducibility) and validity reported?

Page 25: How to use medical literature

Prospective, expensive (Framingham)

Are the subjects representative of the population to which the findings are applied?

Is there evidence of volunteer bias?

Was there adequate follow-up time?

What was the drop-out rate?

Page 26: How to use medical literature

Retrospective, often few cases, cheap

Were records of cases and controls reviewed blindly?

How were possible selection biases controlled (Prevalence bias, Admission Rate bias, Volunteer bias, Recall bias,Lead Time bias, Detection bias, etc)?

Page 27: How to use medical literature

Do the authors specify how the

literature review was conducted? Did

they make any effort to overcome

publication bias? (File Drawer Effect)?

Page 28: How to use medical literature

Were the criteria for inclusion and

exclusion of studies clearly stated?

If significant findings were determined,

did the authors specify the number of

additional negative studies that would

be needed to eliminate the observed

significance?

Page 29: How to use medical literature

How were subjects chosen or recruited? If not random, are they representative of the population?(Random selection is not random assignment)

Page 30: How to use medical literature

Types of Blinding (Masking) Single, Double, Triple.

Is there a control group? How was itchosen?

Page 31: How to use medical literature

How are patients followed up? Who are the dropouts? Why and how many are there?

How is the data quality insured? Response rates? Reliability? Independent review of data? Compliance?

Page 32: How to use medical literature

Are the independent (predictor) and

dependent (outcome) variables in the

study clearly identified, defined, and

Measured?

Page 33: How to use medical literature

Do the authors explain or reference

any unusual methods?

Are statistical methods specified in

sufficient detail (If I had access to the

raw data, could I reproduce the

analysis)?

Page 34: How to use medical literature

Is there a statement about sample size

issues or statistical power (Especially

important in negative studies)?

If a multicenter study, what quality

assurance measures were employed to

obtain consistency across sites?

Page 35: How to use medical literature

If a study involves human subjects,

human tissues, or animals, was

approval from appropriate

institutional or governmental entities

obtained?

Page 36: How to use medical literature

Do the results relate to research

questions and the purpose of the

study?

Do Statistical tests answer the

research question?

Are many Statistical tests performed

and many comparisons made (Data

Dredging)?

Page 37: How to use medical literature

Are actual values reported (Means,

Standard Deviations, Frequencies, etc)

and not just the results of statistical

tests?

Page 38: How to use medical literature

Are groups similar at baseline? If not,

were appropriate adjustments made?

Are informative and appropriate

graphics used to present results

clearly?

Page 39: How to use medical literature

Are the questions posed in the study

adequately addressed?

Are the conclusions justified by the data?

Do the authors extrapolate beyond the data?

Are shortcomings of the study addressed

and constructive suggestions given for

future research?

Page 40: How to use medical literature

Do the citations follow one of the

Council of Biological Editors’ (CBE)

standard formats?

Several ‘dialects’ exist, but in general,

can you find the cited paper or book?

Page 41: How to use medical literature

Merits of the paper Findings presented; honest, reproducible

or not. Will it affect what I do? Beneficial? How does it co-relate with our own

experinece?

Page 42: How to use medical literature

What needs to be done next?

…….more research? …….change in practice?

Page 43: How to use medical literature

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