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Critical appraisal

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27 papers 100 to 500 followers
By Faye Kehler Family Physician and GP Anesthetist since 1987 interested in all aspects of Medicine
Stephen Hearns
No abstract text is available yet for this article.
September 2018: Emergency Medicine Journal: EMJ
Antti Malmivaara
The GRADE method (Grading of Recommendations, Assessment, Development, and Evaluation) provides a tool for rating the quality of evidence for systematic reviews and clinical guidelines. This article aims to analyse conceptually how well grounded the GRADE method is, and to suggest improvements. The eight criteria for rating the quality of evidence as proposed by GRADE are here analysed in terms of each criterion's potential to provide valid information for grading evidence. Secondly, the GRADE method of allocating weights and summarizing the values of the criteria is considered...
February 2015: Annals of Medicine
Mohammad Al Deeb, Aftab Azad, David Barbic
ABSTRACTNoninferiority (NI) trials aim to show that a new treatment or drug is not inferior to a standard, accepted treatment. The rapid proliferation of NI trials within the literature makes it imperative for emergency physicians to be able to read, interpret, and appraise critically this type of research study. Using several emergency medicine examples from the recent literature, this article outlines the key differences between traditional, superiority randomized controlled trials and NI trials. We summarize four important points that an emergency physician should consider when critically appraising an NI trial: 1) Does the new treatment have tangible benefits over the standard treatment? 2) Was the choice of the NI margin appropriate? 3) Was the effect of the standard treatment preserved? Does the trial have assay sensitivity? and 4) What type of analysis strategy was employed: intention-to-treat (ITT) or per protocol (PP)?...
August 2014: CJEM
Paul Cronin, James V Rawson, Marta E Heilbrun, Janie M Lee, Aine M Kelly, Pina C Sanelli, Brian W Bresnahan, Angelisa M Paladin
Recent efforts have been made to standardize the critical appraisal of clinical health care research. In this article, critical appraisal of diagnostic test accuracy studies, screening studies, therapeutic studies, systematic reviews and meta-analyses, cost-effectiveness studies, recommendations and/or guidelines, and medical education studies is discussed as are the available instruments to appraise the literature. By having standard appraisal instruments, these studies can be appraised more easily for completeness, bias, and applicability for implementation...
September 2014: Academic Radiology
C García Villar
Different types of critically appraised topics (CATs) can be elaborated in diagnostic imaging: comparison of diagnostic tests, evaluation of techniques for early detection (screening), economical analyses, or therapeutic aspects, among others. Their design will vary in function of the question they aim to answer. For example, for treatment evaluation, clinical trials are the best, but if there are secondary studies (systematic reviews or meta-analyses) that synthesize information from several studies, the results will be more important and the scientific conclusions will be more relevant...
September 2014: Radiología
Magdalena Krintus, Marek Kozinski, Jacek Kubica, Grazyna Sypniewska
Despite great progress in prevention strategies, pharmacotherapy and interventional treatment of coronary artery disease (CAD), cardiovascular events still constitute the leading cause of mortality and morbidity in the modern world. Traditional risk factors, including hypertension, diabetes mellitus, smoking, obesity, dyslipidemia, and positive family history account for the occurrence of the majority of these events, but not all of them. Adequate risk assessment remains the most challenging in individuals classified into low or intermediate risk categories...
October 2014: Critical Reviews in Clinical Laboratory Sciences
Michelle Lin, Jonathan Fisher, Wendy C Coates, Susan E Farrell, Philip Shayne, Lauren Maggio, Gloria Kuhn
OBJECTIVES: The objective was to critically appraise and highlight medical education research published in 2012 that was methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine (EM). METHODS: A search of the English language literature in 2012 querying Education Resources Information Center (ERIC), PsychInfo, PubMed, and Scopus identified EM studies using hypothesis-testing or observational investigations of educational interventions...
March 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Somaya Hosny, Mona S Ghaly
BACKGROUND: Faculty of Medicine, Suez Canal University is adopting an innovative curriculum. Evidence-based medicine (EBM) has been integrated into problem based learning (PBL) sessions as a responsive innovative paradigm for the practice and teaching of clinical medicine. AIMS: To integrate EBM in the problem based sessions of the sixth-year students, and to assess students' and tutor satisfaction with this change. METHODS: EBM training was conducted for sixth-year students (196) including four theoretical, and eight practical sessions...
April 2014: Medical Teacher
Steven M Green, David L Schriger, Donald M Yealy
Clinical decision rules are increasingly prominent in medicine, particularly in emergency care. The quality, use, and impact of current published decision rules widely vary, requiring clinicians to be critical consumers. We present an approach to assist in the appraisal of clinical decision rules and in judging when to use such rules.
September 2014: Annals of Emergency Medicine
Dragan Ilic, Stephen Maloney
CONTEXT: The principles of evidence-based medicine (EBM) provide clinicians with the ability to identify, source, appraise and integrate research evidence into medical decision making. Despite the mantra of EBM encouraging the use of evidence to inform practice, there appears little evidence available on how best to teach EBM to medical trainees. A systematic review was performed to identify what type of educational method is most effective at increasing medical trainees' competency in EBM...
February 2014: Medical Education
Tamara Tuuminen, Kari Lounamo, Marjatta Leirisalo-Repo
On a population-based level, the incidence of reactive arthritis (ReA) is 0.6-27/100,000. The definition of ReA varies and its pathogenesis is not yet clear. Attempts in basic immunology to suggest hypotheses for proliferation of forbidden B cell clones, molecular mimicry, and involvement of cross-reactive antibodies are helpful but not sufficient. Importantly, for the clinical diagnosis of the preceding infection, serology is widely used. Unfortunately, the accuracy of associations between serologic findings and clinical conclusions is plagued by poor standardization of methods...
December 4, 2013: Frontiers in Immunology
Allan D Sniderman, Kevin J LaChapelle, Nikodem A Rachon, Curt D Furberg
Clinical decisions are increasingly driven by evidence-based recommendations of guideline groups, which aim to be based on the highest quality knowledge-randomized clinical trials (RCTs) and meta-analyses. Although RCTs provide the best assessment of the overall value of a therapy, high-quality evidence from RCTs is often incomplete, contradictory, or absent even in areas that have been most exhaustively studied. Moreover, the likelihood of the success or failure of a therapy is not identical in all the individuals treated in any trial because therapy is not the only determinant of outcome...
October 2013: Mayo Clinic Proceedings
Leslie Citrome
Evidence-based medicine (EBM) is a broad concept, but the key elements include the incorporation of clinical judgment (which requires clinical experience) together with relevant scientific evidence while remaining mindful of the individual patient's values and preferences. Using the framework and philosophy of EBM, this systematic review summarizes the pharmacology, efficacy, and tolerability of newly approved oral antipsychotics, including iloperidone, asenapine, and lurasidone, and outlines what is known about agents that are in late-stage clinical development, such as cariprazine, brexpiprazole, zicronapine, bitopertin, and EVP-6124...
November 2013: CNS Drugs
Richard Hoffman, Mariette Gerber
This review outlines the limitations of current techniques for evaluating the Mediterranean diet in Mediterranean versus non-Mediterranean populations. Differences between the two populations with regard to the foods that are available, food processing and preparation techniques, and eating and lifestyle habits may influence the implementation and effects of a Mediterranean diet in non-Mediterranean regions. For example, the composition of food groups may vary significantly, due to differences in the specific foods within a food group and to differences in aspects of food production and preparation...
September 2013: Nutrition Reviews
Jonathan Fisher, Michelle Lin, Wendy C Coates, Gloria J Kuhn, Susan E Farrell, Lauren A Maggio, Philip Shayne
OBJECTIVES: The objective was to critically appraise and highlight medical education research studies published in 2011 that were methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine (EM). METHODS: A search of the English language literature in 2011 querying PubMed, Scopus, Education Resources Information Center (ERIC), and PsychInfo identified EM studies that used hypothesis-testing or observational investigations of educational interventions...
February 2013: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Brendan Clarke, Donald Gillies, Phyllis Illari, Federica Russo, Jon Williamson
According to current hierarchies of evidence for EBM, evidence of correlation (e.g., from RCTs) is always more important than evidence of mechanisms when evaluating and establishing causal claims. We argue that evidence of mechanisms needs to be treated alongside evidence of correlation. This is for three reasons. First, correlation is always a fallible indicator of causation, subject in particular to the problem of confounding; evidence of mechanisms can in some cases be more important than evidence of correlation when assessing a causal claim...
December 2013: Preventive Medicine
Davide Giavarina
Studies of accuracy are often more complex to understand than clinical trials, since there can be more than one outcome and scope (screening, diagnosis, and prognosis) and because results have to be reported in more than one way, than in clinical trials (relative risk or odds ratio). Sensitivity and specificity are common terms for practitioners, but to remember that sensitivity is the "ratio between true positive rate and true positive rate plus false negative rate" may sometime cause some frustration...
December 2012: Autoimmunity Reviews
Jennifer Frankovich, Christopher A Longhurst, Scott M Sutherland
Many physicians take great pride in the practice of evidence-based medicine. Modern medical education emphasizes the value of the randomized, controlled trial, and we learn early on not to rely on anecdotal evidence. But the application of such superior evidence, however admirable the ambition, can..
November 10, 2011: New England Journal of Medicine
Tasha R Stanton, Mark J Hancock, Christopher G Maher, Bart W Koes
BACKGROUND: Clinical prediction rules (CPRs) for treatment selection in musculoskeletal conditions have become increasingly popular. PURPOSE: The purposes of this review are: (1) to critically appraise studies evaluating CPRs and (2) to consider the clinical utility and stage of development of each CPR. DATA SOURCES: Pertinent databases were searched up to April 2009. Studies aiming to develop or evaluate a CPR for treatment response in musculoskeletal conditions were included...
June 2010: Physical Therapy
Thomas McGinn, Ramiro Jervis, Juan Wisnivesky, Sheri Keitz, Peter C Wyer
BACKGROUND: Clinical prediction rules (CPR) are tools that clinicians can use to predict the most likely diagnosis, prognosis, or response to treatment in a patient based on individual characteristics. CPRs attempt to standardize, simplify, and increase the accuracy of clinicians' diagnostic and prognostic assessments. The teaching tips series is designed to give teachers advice and materials they can use to attain specific educational objectives. EDUCATIONAL OBJECTIVES: In this article, we present 3 teaching tips aimed at helping clinical learners use clinical prediction rules and to more accurately assess pretest probability in every day practice...
August 2008: Journal of General Internal Medicine
2014-11-07 20:28:10
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