1. James A. Hokanson, Ph.D. Department of Preventive Medicine and Community Health University of Texas Medical Branch

2. Questions to ask of every paper you are willing to read 2

3. کیفیت شواهد پزشکی !! 3

4. آیا وقت من ارزش خواندن این مقاله را دارد؟

5. States the Purpose of Article, Major Procedures and Methods, Main Findings, and Conclusions بکارگیری خلاصه مقاله های دارای ساختار (Structured) درحال همه گیر شدن توسط مجلات علمی است. 5

6. Objectives Study Design Methods Results Conclusions 6

7. designed analyzed If properly designed and analyzed, is this study, important and worth knowing about? 7

8. statistically If the results are statistically significant significant, do they also have clinical significance? not statistically detect If the results are not statistically significant, was the sample size sufficiently large to detect a meaningful difference or effect? 8

9. Why is this study needed ? purpose What is the purpose of this study? known before Was purpose known before the study or a chance finding discovered as part of ‘data dredging? ’ 9

10. done before What has been done before and how does this study differ?  Places study in proper context such as  Inadequacies of earlier work  Next step in an overall research project DISCUSSION May also be found in DISCUSSION 10

11. location study Does the location of the study have Relevance Relevance (TO ME)? population What is the population to which the study findings apply? 11

12. time period Is the time period covered by the study Appropriate Appropriate (TO ME). censoring  Long studies may have informative censoring.  Short studies may not have adequate follow-up follow-up time. 12

13. snap-shot A snap-shot in time for the study population sample selected Was the sample selected in an appropriate manner (random, convenience, etc)? 13

14. efforts Were efforts made to ensure a good minimize response rate or to minimize the missing data occurrence of missing data? reproducibility Were reliability (reproducibility) and validity reported? 14

15. Prospective, expensive (Framingham ) representative Are the subjects representative of the population population to which the findings are applied? volunteer bias 1. Is there evidence of volunteer bias? follow-up time 2. Was there adequate follow-up time? drop-out rate 3. What was the drop-out rate? 15

16. few cases, cheap Retrospective, often few cases, cheap Were records of cases and controls blindly reviewed blindly? selection biases How were possible selection biases controlled (Prevalence bias, Admission Rate bias, Volunteer bias, Recall bias, Lead Time bias, Detection bias, etc)? 16

17. inclusion Were the criteria for inclusion and exclusion exclusion of studies clearly stated? If significant findings were determined, did the authors specify the number of negative additional negative studies that would be needed to eliminate the observed significance? 17

18. How chosen How were subjects chosen or recruited? If not random, are they representative representative of the population? 18

19. Blinding Types of Blinding (Masking) Single, Double, Triple. control group Is there a control group? How was it chosen? 19

20. followed up How are patients followed up? Who dropouts are the dropouts? Why and how many are there? How is the data quality insured? Response rates? Reliability? Independent review of data? Compliance? 20

21. independent Are the independent (predictor) and dependent dependent (outcome) variables in the study clearly identified, defined, and Measured Measured ? 21

22. Do the authors explain or reference any unusual methods? statistical methods Are statistical methods specified in sufficient detail (If I had access to the raw data, could I reproduce the analysis)? 22

23. Is there a statement about sample size statistical power issues or statistical power ? multicenter study If a multicenter study, what quality assurance measures were employed to consistency obtain consistency across sites? 23

24. If a study involves human subjects, human tissues, or animals, was approval from appropriate institutional institutional or governmental entities obtained? 24

25. relate Do the results relate to research questions and the purpose of the study? Statistical tests answer Do Statistical tests answer the research question? 25

26. Are actual values reported Are actual values reported (Means, Standard Deviations, Frequencies, etc) and not just the results of statistical tests? 26

27. Are groups similar at baseline Are groups similar at baseline? If not, were appropriate adjustments made? Are informative and appropriate graphics graphics used to present results clearly ? 27

28. questions Are the questions posed in the study addressed adequately addressed? Are the conclusions justified by the data? Do the authors extrapolate beyond the data? Are shortcomings of the study addressed and constructive suggestions given for future research future research? 28

29. Do the citations follow one of the Council of Biological Editors Council of Biological Editors’ (CBE) standard formats? Several ‘dialects’ exist, but in general, can you find the cited paper or book? 29

30. Is the list of contributors reasonable? disclose financial Do authors disclose financial product relationships for product endorsement, consulting arrangements, etc? 30

31. 31