Critically Appraising a Journal Article

What is a Journal Club? An educational meeting in which a group of individuals read, evaluate and discuss current articles from the biomedical literature A collective forum to provide a venue to keep up with the literature One of the most effective means by which students and professionals keep up with current biomedical literature Evidence based practice in action

What is a Journal Club? Classic learning and information sharing format Focused on current literature “Just-in-time” delivery Critically appraised information with commentary and discussion for applicability and relevance

What is a Journal Club? The earliest reference to a journal club is found in a book of memoirs and letters by the late Sir James Paget, a British surgeon and one of the founders of modern pathology. He describes a group at St. Bartholomew's Hospital in London in the mid-1800s with 'a kind of club ... a small room over a baker's shop near the Hospital-gate where we could sit and read the journals.‘ Paget S: Memoirs and Letter of Sir James Paget. London: Long-mans, Green, and Co., 1901:42

What is a Journal Club? It is believed that Sir William Osler established the first formal journal club at McGill University in Montreal in 1875, though Osler himself might have been aware of similar gatherings that were taking place elsewhere. The purpose of Osler's early journal club was 'for the purchase and distribution of periodicals to which he could ill afford to subscribe‘ Linzer M: The journal club and medical education: over one hundred years of unrecorded history. Postgrad Med J 1987,63:475-478.

Successful Journal Clubs include: A well constructed clinical question Searching for evidence A critical appraisal Commentary and discussion

Successful Journal Clubs include: A well constructed clinical question Asking a “well-built clinical question” will facilitate your search for and acquisition of the answer. The clinical question being investigated is asked in the PICO format (Patient/population, intervention, comparison, outcome) More to come!

Successful Journal Clubs include: Searching for evidence Search for articles using your well-built question. Identify what type of question you are asking (therapy, prevention, cost-analysis, etc) and what type of studies (RCT, cohort, case reports) are best for evaluating the answer to your question

Successful Journal Clubs include: A critical appraisal Evaluate the articles you have selected You may use the Critical Appraisal Worksheet

Benefits of Critical Appraisal An analytical summary and evaluation of a research study Standard approach: recognize important information Standard format: easily digested, a quick read Usable by professionals in busy practices as summarized, synthesized evidence

Method of Appraisal There are a number of methods used to critically appraise an article. They all have the same basic format. The method that we are using is based on one developed by Duke University. It is a method that you will see in journal clubs in your 3rd year clerkships and in your residency program encounters.

Successful Journal Clubs include: Commentary and discussion It is also helpful to look for any accompanying editorial commentary, which can provide a unique perspective on the article and highlight controversial issues.

Anatomy of a Scientific Article Abstract Introduction Materials and Methods Results Discussion Conclusion

Always Ask Six Things As you go through the anatomy of the article, you will always ask six things that will correspond to the various parts of the article.

Always Ask Six Things 1) What is the clinical question? 2) Why was the question asked? 3) What did they do? Methods 4) What was the answer ? Results 5) What did they say about the answer? Conclusion 6) What do I do with this information? Is this study of significant enough quality in method to change my practice one way or the other? - (Studies done different ways mean different things) (Look at commentary/discussion)

Always Ask Six Things 1) What is the clinical question? 2) Why was the question asked? 3) What did they do? Methods 4) What was the answer ? Results 5) What did they say about the answer? Conclusion 6) What do I do with this information? Is this study of significant enough quality in method to change my practice one way or the other? - (Studies done different ways mean different things) (Look at commentary/discussion)

1. What is the Clinical Question? What type of question is being asked in your article? This is typically found in the Introduction (See Critical Appraisal Checklist based on Duke University’s Evidence Based Practice)

Diagnostic Test For clinicians to use a diagnostic test in clinical practice, they need to know how well the test distinguishes between those who have the suspected disease or condition and those who do not. Diagnostic test studies evaluate a test for diagnosing a disease.

Differential Diagnosis Differential Diagnosis involves the process of weighing the probability that one disease rather than another disease accounts for a patient’s illness. The Differential Diagnosis Study tries to sort out what proportion of the patients with a single sign or symptom has various diseases.

Economic Analysis An economic analysis can provide accurate values to assess the cost of disease and the cost-benefit of interventions.

Harm / Etiology A Harm/Etiology study addresses how to identify causes for disease (including iatrogenic forms – ie caused by the healthcare system)

Prognostic A prognostic study addresses how to estimate the patient’s likely clinical course over time and anticipate likely complications of disease.

Practice Guideline A practice guideline study is a systematically developed statement on medical practice that assists a practitioner and a patient in making decisions about appropriate health care for specific medical conditions. 

Qualitative Study A qualitative study deals with phenomena that are difficult or impossible to quantify mathematically, such as beliefs, meanings, attributes, and symbols

Systematic Review A systematic review is a literature review focused on a single question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. A meta-analysis is a survey in which the results of all of the included studies are similar enough statistically that the results are combined and analyzed as if they were one study.

Therapy A therapy study addresses how to select treatments to offer patients that do more good than harm and that are worth the efforts and costs of using them.

Question! Students participate in PollEverywhere Question

Always Ask Six Things 1) What is the clinical question? 2) Why was the question asked? 3) What did they do? Methods 4) What was the answer ? Results 5) What did they say about the answer? Conclusion 6) What do I do with this information? Is this study of significant enough quality in method to change my practice one way or the other? - (Studies done different ways mean different things) (Look at commentary/discussion)

2. Why was the question asked? What did the author/s want to know? This is typically found in the Introduction

Always Ask Six Things 1) What is the clinical question? 2) Why was the question asked? 3) What did they do? Methods 4) What was the answer ? Results 5) What did they say about the answer? Conclusion 6) What do I do with this information? Is this study of significant enough quality in method to change my practice one way or the other? - (Studies done different ways mean different things) (Look at commentary/discussion)

3. What did they do? (Methods) You look for the validity of the study by checking the way it was carried out.

3. What did they do? (Methods) Validity The degree to which the results of a study are likely to be true, believable and free of bias.

3. What did they do? (Methods) Bias Deviation of results or inferences from the truth, or processes leading to such deviation. Recall Selection Cultural Conflict of Interest Economic Lead Time Length Time

Types of Studies There are various types of studies for evaluating the answer to your question

TYPES OF STUDIES

Activity Students participate in a group activity.

Always Ask Six Things 1) What is the clinical question? 2) Why was the question asked? 3) What did they do? Methods 4) What was the answer ? Results 5) What did they say about the answer? Conclusion 6) What do I do with this information? Is this study of significant enough quality in method to change my practice one way or the other? - (Studies done different ways mean different things) (Look at commentary/discussion)

4. What was the answer? (Results) What was the consequence, effect, or outcome of the study? This is found in the Results

Always Ask Six Things 1) What is the clinical question? 2) Why was the question asked? 3) What did they do? Methods 4) What was the answer ? Results 5) What did they say about the answer? Conclusion 6) What do I do with this information? Is this study of significant enough quality in method to change my practice one way or the other? - (Studies done different ways mean different things) (Look at commentary/discussion)

5. What did they say about the answer? Conclusion What was the decision reached? This is typically in the Conclusion

Always Ask Six Things 1) What is the clinical question? 2) Why was the question asked? 3) What did they do? Methods 4) What was the answer ? Results 5) What did they say about the answer? Conclusion 6) What do I do with this information? Is this study of significant enough quality in method to change my practice one way or the other? - (Studies done different ways mean different things) (Look at commentary/discussion)

6. What do I do with this information? Is this study of significant enough quality in method to change my practice one way or the other? Look at the commentary and discussion that has been provided by the author/s in the journal article.

Commentary and Discussion After you have appraised the commentary/discussion part of the article, your Journal Club will end with the journal club participants engaging in commentary and discussion about the article. It is also helpful to look for any accompanying editorial commentary, which can provide a unique perspective on the article and highlight controversial issues. Look up your article and see if there are any comments affiliated with your article.

Where to find Commentary PubMed http://www.ncbi.nlm.nih.gov/pubmed/?otool=musmlib Google Scholar http://scholar.google.com.medlib-proxy.mercer.edu/ ACP Journal Club http://annals.org.medlib-proxy.mercer.edu/journalclub.aspx Cochrane Journal Club http://www.cochranejournalclub.com.medlib-proxy.mercer.edu/ Evidence Based Medicine http://ebm.bmj.com.medlib-proxy.mercer.edu/