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Topic 6CRITICAL APPRAISAL

OF MEDICAL ARTICLES

Jarmila PotomkováMedical Librarian

Jan StrojilDepartment of Pharmacology

Palacky University Faculty of MedicinePalacky University Faculty of MedicineOlomouc, Czech RepublicOlomouc, Czech Republic

Updated February 2009Updated February 2009potomkov@tunw.upol.cz

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CRITICAL APPRAISALIN GENERALTechnique, skill Increasing effectiveness of your

reading Excluding poorly designed studies Helping decide

which articles could influence your daily work

which are unsuitable.

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Searching for Best Evidence„Well-built Questions“

Crohn´s Disease: A Role of Psychotherapy

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Live Case ScenarioUniversity Hospital Olomouc : 2007

Case 16-year old boy, Crohn´s diasease diagnosed

in the age of 13; Hospitalized for relapse of disease; In a series of interviews he disclosed

pharmacologic treatment noncompliance

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Foreground Question: PICO Format P/Patient, population, problem adolescent boy; Crohn´s disease/relapse I/Intervention drug treatment C/Comparison druh treatment + psychological therapy O/Outcome improved quality of life

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Background QuestionWhat is Crohn´s disease? Crohn's disease is a chronic inflammation of the intestinal

wall that may affect any part of the digestive tract.

In the past few decades, Crohn's disease has become more common worldwide.

It is most common among populations living in northern climates in developed areas of the world.

It occurs about equally in both sexes, often runs in families. Most people develop Crohn's disease before age 35, usually

between the ages of 15 and 25.

Typical symptoms include chronic diarrhea (which sometimes is bloody), crampy abdominal pain, fever, loss of appetite, and weight loss.

Although Crohn's disease has no known cure, many drugs help reduce inflammation and relieve symptoms. .

Source: Merck Manual – Home Edition. Available from:http://www.merckmanual.com

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Merck Manual – Home Edition

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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: Crohn* AND psychotherapy

OR: Widens your search as either term can be present in all retrieved articles Example: psychotherap* OR psycholog*

OR counsel* OR educat*

NOT: Limits your search by excluding a concept as one term must be present and the second term must not be present Example: Crohn* NOT surgery

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Truncation * PubMed finds all terms that begin

with a given text string Example

Crohn* PubMed retrieves: Crohn disease, Crohn´s

disease ,,,,,,,,,

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Crohn´s disease : a role of psychotherapySearch terms

Crohn(´s) disease

Psychotherapy Psychological therapy Counselling Patient education Psychosomatic

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Search Strategy SuggestionsStep 1Crohn* Limits: Title

Step 2psychotherap* OR psycholog* OR psychosomatic OR counsel*

OR educat* Limits: Title/Abstract

Step 3Combine searches #1 AND #2

Step 4 Limits: Type of article/Randomized controlled trial

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Combine Searches

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Combine Searches - Results

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Limits: Type of Article: Randomized Controlled Trial

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Original ArticlesRandomized Controlled Trials

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PubMed Search ResultsAll: 145

Reviews: 24 Traditional („narrative“) Systematic + Meta-analysis (pre-

determined criteria of study inclusion) Randomized Controlled Trials: 9

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Example of Randomized Controlled Trial Keller W. et al. Effect of psychotherapy and relaxation on

the psychosocial and somatic course of Crohn's disease: main results of the German Prospective Multicenter Psychotherapy Treatment study on Crohn's Disease.

J Psychosom Res. 2004;56(6):687-96. J

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RCT for Critical Appraisal

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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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Any Published Comments on Article?

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Commentary

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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