What is critical appraisal

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What is critical appraisal?
by
SOMPON TASSNIYOM MD,MSc
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From dictionary
critical appraisal an appraisal on careful
analytical evaluation Appraisal, assessment -
the classification of someone or something
with respect to its worth Criticism, critique
a serious examination and judgment of
something constructive criticism is always
appreciated
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Critical appraisal is the process of
systematically examining research evidence
to assess its validity, results and relevance
before using it to inform a decision Critical
appraisal is one step in the process of
evidence-based clinical practice
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Evidence-based clinical practice is an
approach to decision making in which the
clinician uses best evidence available,
in consultation with the patient, to decide
the option which suits the patient best
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To determine what is the best evidence, we
need critical appraisal skills that will
help us to understand the methods and
results of research and to assess the quality
of the research
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Most research is not perfect, and critical
appraisal is not an exact science -it will
not give us the right answer. But it can help
us to decide whether we think a reported
piece of research is good enough to be used
in decision-making
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There are many factors that come into play
when making healthcare decisions -research
evidence is just one of them If research has
flaws, it is up to readers to use their
critical appraisal skills to decide whether
this affects the usefulness of the paper in
influencing their decision
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Pros of critical appraisal in practice
Critical appraisal provides a systematic way
of assessing the validity,
results and usefulness of
published research papers
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Together with skills in finding research
evidence and changing practice as a result of
research, Critical appraisal is the route to
closing the gap between research and
practice and as such makes an essential
contribution to improving healthcare quality
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Critical appraisal encourages objective
assessment of the usefulness of information
Critical appraisal skills are applied to
published research, but all evidence should
be appraised to weigh up its usefulness
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Critical appraisal skills are not difficult to
develop Critical appraisal is a common sense
approach to reading and user-friendly
tools are available to help anyone develop
these skills
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Cons of critical appraisal in practice
Critical appraisal can be time-consuming
initially, although with time it becomes the
automatic way to look at research papers
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Critical appraisal does not always provide
the reader with the easy answer or the
answer one might have hoped for It may
highlight that a favoured intervention is in
fact ineffective
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Critical appraisal can be dispiriting if it
highlights a lack of good evidence It may take
determination to persist with an area of
interest when access to good research in the
area is limited
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Key to the practice of EBM
Critical appraisal issues must arise from
patient problems. Most patient problems fall
into one or more of the following
categories ? Therapy ? Diagnostic Tests ?
Prognosis ? Harm (etiology, association,
risk, exposure, etc.) ?
Cost-effectiveness
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Since 1992, the EBM working group from
McMaster University has published several
articles on critical appraisal The reader should
refer to the JAMA Users Guides to the
Medical Literature
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Critical Appraisal of any article has four
basic parts
What is the clinical QUESTION? Are the results
VALID? What are the RESULTS? Are the results
APPLICABLE to my patients?
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Grouping of critical appraisal tools
? Appraisal of original research ? Appraisal of
reviews ? Appraisal of qualitative studies
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Critical Appraisal tools
1. How to Use an Article on Therapy 2. How to Use
an Article About a Diagnostic Test 3. How to Use
an Article About Harm 4. How to Use an Article
About Prognosis 5. How to Use an Overview 6. How
to Use a Clinical Decision Analysis
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7. How to Use a Clinical Practice Guideline
8. A Method for Grading Health Care
Recommendations 9. How to Use an Article
Reporting Variations in the Outcomes of Health
Services 10. How to Use an Article About a
clinical Utilization Review
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