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Topic 7How to read medical
journal articles. Worked examples.
Jarmila PotomkováMedical Librarian
Jiri GalloDepartment of Orthopaedic Surgery
Palacky University Faculty of MedicinePalacky University Faculty of MedicineOlomouc, Czech RepublicOlomouc, Czech Republic
Updated February 2009Updated February [email protected]
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CASP – Critical Appraisal Skills Programme: Appraisal Tools
http://www.phru.nhs.uk/Pages/PHD/CASP.htm
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CASPRCT – Screening Questions
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Commentary
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Any Published Comments on Article?
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Professional Databases with Critically Appraised Topics
Clinical Evidencehttp://www.clinicalevidence.com (fee) Systematic reviews
Question(s) Option(s)
Grades of evidence Beneficial Likely beneficial Trade off between benefit and harm Unknown effectiveness Unlikely beneficial Etc.
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Clinical EvidenceInterventions: Questions
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Clinical EvidenceReady-to-use „Appraised Knowledge“
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Searching – Finding - Reading
Osteoarthritis of the knee :
Treatment with corticosteroids
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Adapted from:Evidence-Based Practice Workbook2 ed. by P. Glasziou et al., BMJ Books, 2007
Objectives:
To determine the efficacy of intra—articular corticosteroid injections for osteoarthritis in the knee.
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Background QuestionWhat is osteoarthritis?Sources:
• Merck Manual of Diagnosis and Therapy• Merck Manual – Home Edition.• Available from:http://www.merckmanual.com
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osteoarthritis +knee+corticosteroids
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PubMed Search ConsolidationSearch Strategy Selection of search terms
Keywords Phrases Synonyms
Combination of search terms Boolean logic
Application of limits Occurrence of search terms
Title, Title/Abstract, All fields Types of articles Age groups Etc.
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Boolean logic AND: Combines terms to limit your search as both
concepts must be present in all retrieved articles Example: osteoarthritis AND knee*
OR: Widens your search as either term can be present in all retrieved articles Example: osteoarthritis OR arthritis
NOT: Limits your search by excluding a concept as one term must be present and the second term must not be present Example: osteoarthritis NOT hip
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Truncation * PubMed finds all terms that begin with
a given text string Example
osteoarthriti* PubMed retrieves: osteoarthritis,
osteoarthritic,,,,,,,,
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Osteoarthritis of the knee : treatment with corticosteroidsSearch terms:osteoarthriti*; arthriti*knee*corticosteroid*; glucocorticoid*;
steroid*
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Search Strategy SuggestionsStep 1(osteoarthriti* OR arthriti*) AND knee* Limits: Title
Step 2corticosteroid* OR steroid* OR glucocorticoid* Limits: Title
Step 3Combine searches #1 AND #2
Step 4 Limits: Type of articles: Meta-analysis
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Systematic Reviews & Meta-Analysis
Statistical methodsStatistical methods
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Combine Searches
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Limit: Type of article : Meta-analysis
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PubMed Search ResultsAll: 57
Reviews: 8 Meta-analysis: 4
Including Cochrane reviews
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HOMEWORK
Basic Steps of Critical Appraisal of Systematic Reviews/Meta-analyses
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Systematic review (meta-analysis) for critical appraisal
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What question did the study ask? P/Patient, population, problem I/Intervention
C/Comparison
O/Outcome
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How well was the study done?
Rapid Critical Appraisal of a Systematic Review
CHECKLIST
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Does the systematic review address a focused question? (PICO)
The main question being addressed should be clearly stated.
The intervention, such as therapy or diagnostic test, and the outcomes will often be expressed in terms of a simple relationship.
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Where do I find the information? Title, Abstract or final paragraph of the
Introduction should clearly state the question.
If you still cannot ascertain what the focused question is after reading these sections, search for another paper.
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Is the question used to direct the search and select articles for inclusion? The inclusion or exclusion of studies in a
systematic review should be clearly defined a priori.
The eligibility criteria used should specify the patients, interventions and outcomes.
In many cases the type of study design will also be a key component of the eligibility criteria.
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Where do I find information? The Methods section should describe in
detail the inclusion and exclusion criteria. Normally, this will include the study
design.
